Clinical periodontology and implant dentistry: 1 Basic concepts
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| Ausgabe: | 6. ed. |
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| 245 | 1 | 0 | |a Clinical periodontology and implant dentistry |n 1 |p Basic concepts |c ed. by Niklaus P. Lang ; Jan Lindhe |
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| adam_text | Now in its sixth edition, Clinical Periodontology and Implant Dentistry is the must-have resource for practitioners
specializing in periodontal care and implant dentistry. The chapters have been extensively revised with 40% of the
content new to this edition. Maintaining the widely praised two-volume format introduced in the previous edition,
the editorial team has once again brought together the world s top international specialists to share their expertise
on all aspects of periodontology, periodontal health, and the use of implants in the rehabilitation of the periodontally
compromised patient. Seamlessly integrating foundational science, practical clinical protocols, and recent advances in the
field, the sixth edition of Clinical Periodontology and Implant Dentistry enhances its stellar reputation as the cornerstone
reference work on periodontology.
Editors
Professor Niklaus P. Lång is Honorary Professor at the Faculty of Dentistry, The University of Hong Kong, Honorary
Professor at University College London, Guest Professor at the University of Zurich and Professor Emeritus at the
University of Berne.
Professor Jan Lindhe is a world-renowned clinical research scientist specializing in periodontology.
Contents
Contributors, xix
Preface, XXV
Volume 1: BASIC CONCEPTS
Edited by Jan Lindhe and Niklaus P. Lang
Part 1: Anatomy
1 Anatomy of Periodontal Tissues, 3
Jan Lindhe, Thorkild Karring, and Mauricio Araujo
Introduction, 3
Gingiva, 5
Macroscopic anatomy, 5
Microscopic anatomy, 8
Periodontal ligament, 25
Root cementum, 29
Bone of the alveolar process, 34
Macroscopic anatomy, 34
Microscopic anatomy, 36
Blood supply of the periodontium, 41
Lymphatic system of the periodontium, 45
Nerves of the periodontium, 45
Acknowledgment, 46
2 Bone as a Living Organ, 48
Hector F. Rios, Jill D. Bashutski,
and William V. Giannohile
Introduction, 48
Development, 48
Intramembranous bone formation, 48
Endochondral bone growth, 48
Structure, 50
Osseous tissue, 50
Periosteal tissue, 53
Bone marrow, 53
Function, 55
Mechanical properties, 55
Metabolic properties, 55
Skeletal homeostasis, 57
Healing, 57
Disorders, 58
Conclusion, 63
Acknowledgment, 63
3 The Edentulous Ridge, 65
Mauricio Armijo and Jan Lindhe
Clinical considerations, 65
Remaining bone in the edentulous ridge, 68
Classification of remaining bone, 68
Topography of the alveolar process, 69
From an alveolar process to an edentulous ridge, 70
Intra-alveolar processes, 70
Extra-alveolar processes, 78
Topography of the edentulous ridge: Summary, 80
4 The Mucosa at Teeth and Implants, 83
Jan Lindhe, Jan L. Wennström,
and Tord Berglundh
Gingiva, 83
Biologic width, 83
Dimensions of the buccal tissue, 83
Dimensions of the interdental papilla, 84
Peri-implant mucosa, 85
Biologic width, 86
Quality, 90
Vascular supply, 91
Probing gingiva and peri-implant mucosa, 92
Dimensions of the buccal soft tissue
at implants, 94
Dimensions of the papilla between teeth
and implants, 95
Dimensions of the papilla between adjacent
implants, 96
5 Osseointegrarion, 100
Jan Lindhe, Tord Berglundh, and Niklaus P. Lang
Introduction, 100
Implant installation, 100
Tissue injury, 100
Wound healing, 101
Cutting and non-cutting implants, 101
Process of osseointegration, 104
Morphogenesis of osseointegration, 108
Overall pattern of implant integration, 108
Biopsy sample observations, 109
6 From Periodontal Tactile Function to
Peri-implant Osseoperception, 112
Reinhilde Jacobs
Introduction, 112
Neurophysiologic background, 113
Trigeminal neurosensory pathway, 113
Neurovascularization of the jaw bones, 113
VIII
Contents
Mandibular neuroanatomy, 113
Maxillary neuroanatomy, 115
Histologic background, 115
Periodontal innervation, 115
Peri-implant innervation, 117
Testing tactile function, 118
Neurophysiologic assessment, 118
Psychophysical assessment, 118
Periodontal tactile function: Influence of
dental status, 118
From periodontal tactile function to peri-implant
osseoperception, 119
From osseoperception to implant-mediated
sensory-motor interactions, 120
Clinical implications of implant-mediated
sensory-motor interactions, 120
Conclusion, 121
Part 2: Epidemiology
7 Epidemiology of Periodontal Diseases, 125
Panos N. Papapanou and Jan Lindhe
Introduction, 125
Methodologie issues, 125
Examination methods: Index systems, 125
Periodontitis case definition in epidemiologic
studies, 127
Prevalence of periodontal diseases, 130
Periodontitis in adults, 130
Periodontitis in children and adolescents, 135
Periodontitis and tooth loss, 138
Risk factors for periodontitis, 138
Introduction: Definitions, 138
Non-modifiable background factors, 141
Environmental, acquired, and behavioral
factors, 143
Concluding remarks, 154
Acknowledgment, 156
Part 3: Microbiology
8 Dental Biofilms, 169
Philip David Marsh
Introduction, 169
The mouth as a microbial habitat, 169
Significance of a biofilm and community lifestyle
for microorganisms, 171
Formation of dental biofilms, 172
Structure of dental biofilms, 175
Microbial composition of dental biofilms, 177
Benefits to the host of a resident oral
microbiota, 178
Concluding remarks, 179
9 Dental Calculus, 183
Dieter D. Bosshardt and Niklaus P. Lang
Clinical appearance and distribution, 183
Calculus formation and structure, 185
Attachment to tooth surfaces and implants, 186
Calculus composition, 188
Clinical implications, 188
Conclusion, 189
10 Periodontal Infections, 191
Mike Curtis
Introduction, 191
Dysbiosis of the oral microbiota
in periodontal disease, 193
Early microscopic and cultural microbiology
investigations, 195
Advent of anaerobic microbiologie techniques, 195
Targeted microbiologie analyses: Rise of
specificity, 198
Cultural and immunochemical studies, 198
Nucleic acid-based techniques for bacterial
identification, 200
Serologic analyses, 203
Challenge of the unculturable bacteria, 204
The Human Oral Microbe Identification
Microarray, 205
High throughput sequencing revolution, 206
Genetic variation, 206
Influence of a biofilm lifestyle, 208
Periodontal bacteria and virulence, 210
Microbial pathogenesis of periodontal disease, 212
Conclusion, 216
Acknowledgment, 217
11 Peri-implant Infections, 222
Lisa Heitz-Mayfield, Ricardo P. Teles,
and Niklaus P. Lang
Introduction, 222
Peri-implant biofilm formation, 222
Surface characteristics of the
implant/abutment, 223
Local oral environment, 225
Oral hygiene and accessibility, 226
Microbiota associated with peri-implant
mucosal health, 227
Microbiota associated with peri-implant
infections, 229
Patients at risk for peri-implant infections, 232
Anti-infective treatment and microbiologie
effects, 232
Non-surgical mechanical therapy, 232
Non-surgical mechanical therapy and adjunctive
antimicrobial agents, 233
Surgical access and implant surface
decontamination, 233
Part 4: Host-Parasite Interactions
12 Pathogenesis of Gingivitis, 241
Gregory J. Seymour, Leonardo Trombelli,
and Tord Berglundh
Introduction, 241
Development of gingival inflammation, 241
The initial lesion, 241
The early lesion, 243
Individual variations in the development of
gingivitis, 246
Factors influencing the development of gingivitis, 247
Microbiologie factors, 247
Predisposing factors, 247
Modifying factors, 247
Repair potential, 251
Contents
IX
13 Pathogenesis of Periodontitis, 256
Gregory J. Seymour, Toni Berglundh,
and Leonardo Trombelli
Introduction, 256
Histopathology of periodontitis, 257
Established or progressive lesion, 257
Advanced lesion, 257
В cells in periodontitis, 259
T cells in periodontitis: The Thl/Th2
paradigm, 260
Suppression of cell-mediated immunity, 260
T cells and homeostasis, 260
Cytokine profiles, 261
CDS T cells, 261
Immunoregulation in periodontitis, 262
Genetics, 262
Innate immune response, 263
Nature of the antigen, 263
Nature of the antigen-presenting cell, 263
Hypothalamic-pituitary-adrenal axis and the
sympathetic nervous system, 264
Treg/Thl7 axis, 264
Autoimmunity, 265
NK T cells, 265
В-cell subsets, 265
Connective tissue matrix destruction, 265
Bone loss, 266
Conclusion, 266
14 Modifying Factors, 270
Evanthia Lalla and Panos N. Papapanou
Introduction, 270
Diabetes mellitus, 270
Mechanisms underlying the effect of diabetes
on periodontitis, 270
Clinical presentation of the periodontal patient
with diabetes, 272
Concepts related to patient management, 277
Tobacco smoking, 278
Mechanisms underlying the effect of smoking
on periodontitis, 279
Clinical presentation of the periodontal patient
who smokes, 279
Concepts related to patient management, 280
Obesity and nutrition, 282
Osteoporosis and osteopenia, 283
Psychosocial stress, 284
15 Genetic Susceptibility to Periodontal Disease:
New Insights and Challenges, 290
Arne S, Schafer, Ubele van der Velden,
Marfa L. Laine, and Bruno G. Loos
Introduction, 290
Evidence for the role of genetics in periodontitis, 291
Heritability, 292
Heritabilitv of aggressive periodontitis
(earlv-onset periodontitis), 293
Heritabilitv of chronic periodontitis, 296
Gene mutation of major effect on human disease
and its association with periodontitis, 297
Identification of genetic risk factors of
periodontitis, 297
ANRIL, CAMTA1/VAMP3, GLT6D1, COX-2,
and XPY, 301
Epigenetic signatures, 304
From genetic disease susceptibility to improved
oral care, 306
Part 5: Trauma from Occlusion
16 Trauma from Occlusion: Periodontal
Tissues, 313
fan Lindhe and Ingvar Ericsson
Definition and terminology, 313
Trauma from occlusion and plaque-associated
periodontal disease, 314
Analysis of human autopsy material, 314
Clinical trials, 316
Animal experiments, 317
Conclusion, 323
17 Trauma from Occlusion: Peri-implant
Tissues, 325
Niklaas P. Lang and Tord Berglundh
Introduction, 325
Orthodontic loading and alveolar bone, 325
Bone reactions to functional loading, 327
Excessive occlusal load on implants, 327
Static and cyclic loads on implants, 330
Load and loss of osseointegration, 331
Masticatory occlusal forces on implants, 332
Tooth-implant supported reconstructions, 333
Part 6: Periodontal Pathology
18 Non-Plaque-Induced Inflammatory
Gingival Lesions, 339
Palle Holmstrup and Mats fontell
Gingival diseases of specific bacterial origin, 339
Gingival diseases of viral origin, 340
Herpes virus infections, 340
Gingival diseases of fungal origin, 342
Candidosis, 342
Histoplasmosis, 344
Gingival lesions of genetic origin, 345
Hereditary gingival fibromatosis, 345
Gingival diseases of systemic origin, 346
Mucocutaneous disorders, 346
Allergic reactions, 354
Other gingival manifestations of systemic
conditions, 355
Traumatic lesions, 357
Chemical injury, 358
Physical injury, 358
Thermal injury, 359
Foreign body reactions, 360
19 Plaque-Induced Gingival Diseases, 366
Angelo Mariotti
Classification criteria for gingival diseases, 366
Plaque-induced gingivitis, 368
Plaque-induced gingivitis on a reduced
periodontium, 369
Gingival diseases associated with endogenous
hormones, 370
Puberty-associated gingivitis, 370
X
Contents
Menstrual cycle-associated gingivitis, 370
Pregnancy-associated gingival diseases, 370
Gingival diseases associated with medications, 371
Drug-influenced gingival enlargement, 371
Oral contraceptive-associated gingivitis, 372
Gingival diseases associated with systemic diseases, 372
Diabetes mellitus-associated gingivitis, 372
Leukemia-associated gingivitis, 373
Linear gingival erythema, 373
Gingival diseases associated with malnutrition, 374
Gingival diseases associated with heredity, 374
Gingival diseases associated with ulcerative lesions, 375
Treatment of plaque-induced gingival diseases, 375
Significance of gingivitis, 376
Acknowledgment, 376
20 Chronic Periodontitis, 381
Denis Kinane, fan Linàhe, and Leonardo Trombelli
Clinical features of chronic periodontitis, 381
Gingivitis as a risk factor for chronic periodontitis, 382
Susceptibility to chronic periodontitis, 384
Prevalence of chronic periodontitis, 384
Progression of chronic periodontitis, 385
Risk factors for chronic periodontitis, 385
Bacterial factors, 385
Age, 386
Smoking, 386
Systemic disease, 386
Stress, 387
Genetics, 387
Scientific basis for treatment of chronic periodontitis, 387
21 Aggressive Periodontitis, 390
Maurizio S. Tonetti and Andrea Mombelli
Classification and clinical syndromes, 391
Epidemiology, 393
Primary dentition, 394
Permanent dentition, 394
Screening, 396
Etiology and pathogenesis, 399
Bacterial etiology, 400
Genetic aspects of host susceptibility, 404
Environmental aspects of host susceptibility, 407
Current concepts, 407
Diagnosis, 408
Clinical diagnosis, 408
Microbiologie diagnosis, 410
Evaluation of host defenses, 410
Genetic diagnosis, 412
Principles of therapeutic intervention, 412
Elimination or suppression of the pathogenic
flora, 412
22 Necrotizing Periodontal Disease, 421
Palle Holmstrup
Nomenclature, 421
Prevalence, 422
Clinical characteristics, 422
Development of lesions, 422
interproximal craters, 423
Sequestrum formation, 424
Involvement of alveolar mucosa, 424
Swelling of lymph nodes, 424
Fever and malaise, 425
Oral hygiene, 425
Acute and recurrent/chronic forms of necrotizing
gingivitis and periodontitis, 426
Diagnosis, 426
Differential diagnosis, 426
Histopathology, 427
Microbiology, 428
Microorganisms isolated from
necrotizing lesions, 428
Pathogenic potential of microorganisms, 428
Host response and predisposing factors, 430
Systemic diseases, 430
Poor oral hygiene, pre-existing gingivitis, and
history of previous necrotizing periodontal
diseases, 431
Psychological stress and inadequate
sleep, 431
Smoking and alcohol use, 432
Caucasian ethnicity, 432
Young age, 432
Treatment, 432
Acute phase treatment, 432
Maintenance phase treatment, 434
23 Effect of Periodontal Diseases on General
Health, 437
Panos N. Papapanou and Evanthia Lalla
Introduction, 437
Atherosclerotic vascular disease, 438
Biologic plausibility, 438
Epidemiologic evidence, 440
Adverse pregnancy outcomes, 448
Definitions and biologic plausibility, 448
Epidemiologic evidence, 449
Diabetes mellitus, 451
Biologic plausibility, 451
Epidemiologic evidence, 452
Other associations, 455
Chronic renal disease, 455
Pulmonary infections, 455
Concluding remarks, 456
24 Abscesses in the Periodontium, 463
David Herrera, Arie ]. van Winkelhoff
and Mariano Sanz
Introduction, 463
Classification and etiology, 463
Prevalence, 464
Pathogenesis and histopathology, 464
Microbiology, 465
Diagnosis, 466
Differential diagnosis, 467
Treatment, 467
Complications, 469
Tooth loss, 469
Dissemination of the infection, 469
25 Lesions of Endodontic Origin, 472
Gunnar Bergenholtz, Domenico Ricucci,
and José E Siqueira, Jr
Introduction, 472
Disease processes of the dental pulp, 473
Causes, 473
Progression and dynamic events, 473
Accessory canals, 477
Periodontal tissue lesions to primarv root canal
infection, 480
Post-treatment endodontic lesions, 487
Effects of periodontal disease and periodontal therapy
on the condition of the pulp, 489
Contents
XI
Influences of periodontal disease, 489
Influence of periodontal treatment measures, 490
Root dentin hypersensitivity, 492
Part 7: Peri-implant Pathology
26 Peri-implant Mucositis and
Peri-implantitis, 505
Tord Berglundh, Jan Lindhe, and Niklaus P. Lang
Definitions, 505
Peri-implant mucosa, 505
Peri-implant mucositis, 505
Clinical features and diagnosis, 505
Clinical models, 506
Preclinical models, 506
Peri-implantitis, 508
Clinical features and diagnosis, 508
Human biopsy material, 509
Preclinical models, 510
Prevalence of peri-implant diseases, 513
Peri-implant mucositis, 513
Peri-implantitis, 513
Risk factors for peri-implantitis, 515
Patients at risk, 515
Design of suprastructure, 515
Implant surface characteristics, 515
Conclusion, 516
Part 8: Tissue Regeneration
27 Periodontal Wound Healing, 521
Hector F. Rios, D. Kaigler, Christoph A. Ramseier,
G. Rasperini, and William V. Giannobile
Introduction, 521
Wound healing: Outcomes and
definitions, 521
Wound healing biologv, 523
Phases of wound healing, 523
Factors that affect healing, 524
Periodontal wound healing, 525
Healing after periodontal surgery, 526
Advanced regenerative approaches to periodontal
tissue reconstruction, 528
Regenerative surgery, 529
Guided tissue regeneration, 529
Clinical applications of growth factors for use
in periodontal regeneration, 529
Cell therapy for periodontal regeneration, 530
Gene therapeutics for periodontal
tissue repair, 532
Conclusion, 533
Acknowledgment, 533
28 Concepts in Periodontal Tissue
Regeneration, 536
Thorkild Karring and Jan Lindhe
Introduction, 536
Regenerative periodontal surgery, 537
Periodontal wound healing, 537
Regenerative capacity of bone cells, 542
Regenerative capacity of gingival
connective tissue cells, 542
Regenerative capacity of periodontal
ligament cells, 543
Role of epithelium in periodontal wound
healing, 545
Root resorption, 545
Regenerative concepts, 546
Grafting procedures, 547
Root surface biomodification, 548
Guided tissue regeneration, 549
Assessment of periodontal regeneration, 551
Periodontal probing, 551
Radiographic analysis and re-entry
operations, 552
Histologic methods, 552
Conclusion, 552
Index, il
Volume 2: CLINICAL CONCEPTS
Edited by Niklaus P. Lang and Jan Lindhe
Part 9: Examination Protocols
29 Examination of Patients, 559
Giovanni E. Salvi, Tord Berglundh,
and Niklaus P. Lang
Patient s history, 559
Chief complaint and expectations, 559
Social and family history, 559
Dental history, 560
Oral hygiene habits, 560
Smoking history, 560
Medical history and medications, 560
Genetic testing before periodontal and implant
therapy, 560
Signs and svmptoms of periodontal diseases
and their assessment, 560
Gingiva, 562
Keratinized mucosa at implant recipient sites, 563
Periodontal ligament and root cementum, 563
Alveolar bone, 569
Diagnosis of periodontal lesions, 569
Gingivitis, 570
Parodontitis, 570
Oral hygiene status, 571
Additional dental examinations, 571
Conclusion, 571
30 Diagnostic Imaging of the Periodontal
and Implant Patient, 574
Bernard Koong
Introduction, 574
Interpretation of the radiologic examination, 575
Basic prerequisites, 576
Radiologic anatomy, 576
Pathology, 576
Imaging modality, 577
Viewing conditions, 577
XII
Contents
Key steps in interpretation, 577
Recognizing the presence of an abnormality, 577
Radiologic evaluation of a lesion, 577
Interpretation of the findings, 580
Radiologic interpretation in relation to inflammatory
periodontal disease, 580
Key radiologic features, 580
Related factors, 590
Differential diagnosis, 590
Pathology involving other regions of the jaws
and adjacent structures, 591
Frequency of periodontal radiologic
examinations, 591
Implant imaging, 591
Imaging modalities, 593
Intraoral radiographs, 593
Panoramic radiographs, 596
Conventional tomography, 598
Multislice/multidetector computed
tomography and cone-beam computed
tomography, 598
Magnetic resonance imaging, 603
Comparison of radiation dose levels, 604
31 Patient-Specific Risk Assessment for Implant
Therapy, 609
Giovanni E. Salvi and Niklaus P. Lang
Introduction, 609
Systemic factors, 609
Medical conditions, 609
Medications, 611
Age, 612
Growth considerations, 612
Untreated periodontitis and oral hygiene habits, 612
History of treated periodontitis, 613
Compliance with supportive periodontal therapy, 613
Smoking history, 614
Genetic susceptibility traits, 614
Conclusion, 615
Part 10: Treatment Planning Protocols
32 Treatment Planning of Patients with
Periodontal Diseases, 621
Giovanni E. Salvi, Jan Lindhe,
and Niklaus P. Lang
Introduction, 621
Treatment goals, 621
Systemic phase, 622
Initial (hygienic) phase, 622
Corrective phase (additional
therapeutic measures), 622
Maintenance phase (supportive periodontal
therapy), 622
Screening for periodontal disease, 622
Basic periodontal examination, 622
Diagnosis, 624
Treatment planning, 625
Initial treatment plan, 625
Pretherapeutic single tooth prognosis, 626
Case presentation, 628
Concluding remarks, 633
Case report, 633
Patient S.K. (male, 35 years old), 635
33 Treatment Planning for Implant Therapy in
the Periodontally Compromised Patient, 641
Jan L. Wennstriitn and Niklaus P. Lang
Prognosis of implant therapy in the periodontally
compromised patient, 641
Strategies in treatment planning, 642
Treatment decisions: Case reports, 642
Posterior segments, 642
Tooth versus implant, 645
Aggressive periodontitis, 645
Furcation problems, 646
Single-tooth problem in the esthetic zone, 650
Conclusion, 650
34 Systemic Phase of Therapy, 654
Niklaus P. Lang, Christoph A. Ramseier,
and Hans-Rudolf Baur
Introduction, 654
Protection of the dental team and other patients
against infectious diseases, 654
Protection of the patient s health, 655
Prevention of complications, 655
Infection, specifically bacterial endocarditis, 655
Bleeding, 656
Cardiovascular incidents, 657
Allergic reactions and drug interactions, 657
Systemic diseases, disorders or conditions influencing
pathogenesis and healing potential, 657
Specific medications: Bisphosphonates as a threat
to implant therapy, 657
Control of anxiety and pain, 658
Tobacco cessation counseling, 658
Conclusion, 659
Part 11: Initial Periodontal Therapy
(Infection Control)
35 Motivational Interviewing, 663
Christoph A. Ramseier, Jeanie E. Suvan,
and Delwyn Catley
Health behavior change counseling in
periodontal care, 663
The challenge, 664
Communication with the periodontal patient, 664
OARS, 665
Understanding motivational interviewing, 665
General principles, 666
Giving advice, 666
Agenda setting, 667
Readiness scale, 667
Evidence for motivational interviewing, 668
Evidence in general health care, 668
Evidence in dental care, 668
Patient activation fabric, 670
Band I: Establish rapport, 670
Band II: Information exchange, 672
Band III: Closing, 672
Ribbon A: Communication style, 672
Ribbon B: Health behavior change tools, 672
Case examples, 672
Oral hygiene motivation I, 672
Oral hygiene motivation II, 673
Tobacco use cessation, 674
Conclusion, 675
Contents
xiii
36 Mechanical Supragingival Plaque Control, 677
Fridus van der Weijden, Dagmar Else Slot,
josé }. Echeverría, and Jan Lindhe
Importance of supragingival plaque removal, 677
Self-performed plaque control, 678
Brushing, 679
Motivation, 679
Oral hygiene instruction, 680
Toothbrushing, 680
Manual toothbrushes, 680
Electric (power) toothbrushes, 687
Electrically active (ionic) toothbrush, 690
Interdental cleaning, 690
Dental floss and tape, 691
Woodsticks, 692
Interdental brushes, 693
Adjunctive aids, 695
Dental water jets/oral irrigators, 695
Tongue cleaners, 696
Foam brushes, swabs or tooth towelettes, 697
Dentifrices, 697
Side effects, 698
Brushing force, 698
Toothbrush abrasion, 699
Importance of instruction and motivation in mechanical
plaque control, 701
Acknowledgments, 703
37 Chemical Oral and Dental Biofilm
Control, 717
David Herrera and Jorge Serrano
Rationale for supragingival biofilm control, 717
Oral hygiene products, 718
Mechanical biofilm control, 718
Limitations, 718
Chemical biofilm control, 718
Mechanism of action, 719
Categories of formulations, 720
Ideal features, 720
Evaluation of activity of agents for chemical
biofilm control, 720
In vitro studies, 720
In vivo studies, 721
Home-use clinical trials, 722
Active agents, 723
Antibiotics, 723
Enzymes, 723
Amine alcohols, 723
Detergents, 724
Oxygenating agents, 724
Metal salts, 724
Stannous fluoride, 724
Other fluorides, 725
Natural products, 725
Essential oils, 725
Triclosan, 726
Bisbiguanides, 727
Quaternarv ammonium compounds, 730
Hexetidine, 730
Povidone iodine, 731
Other evaluated products, 731
Future approaches, 731
Delivery formats, 731
Mouth rinses, 731
Dentifrices, 732
Gels, 732
Chewing gums, 732
Varnishes, 732
Lozenges, 732
Irrigators, 733
Sprays, 733
Sustained-release devices, 733
Clinical indications for chemical plaque control:
Selection of agents, 733
Single use, 733
Short-term use for the prevention of dental
biofilm formation, 733
Short-term use for therapy, 734
Long-term use for the prevention of dental
biofilm formation, 735
Long-term use for the prevention of other
oral conditions, 735
Conclusion, 736
38 Non-surgical Therapy, 749
Jan L. Wennstrôm and Cristiano Tomasi
Introduction, 749
Goal of non-surgical pocket/root instrumentation, 749
Debridement, scaling, and root planing, 750
Instruments used for non-surgical pocket/root
debridement, 750
Hand instruments, 750
Sonic and ultrasonic instruments, 753
Ablative laser devices, 754
Approaches to subgingival debridement, 755
Full-mouth instrumentation protocols, 755
Full-mouth disinfection protocols, 755
Clinical outcomes following various approaches
to pocket/root instrumentation, 756
Microbiologie outcomes following various approaches
to pocket/root instrumentation, 756
Considerations in relation to selection of instruments
and treatment approach, 759
Selection of instruments, 759
Selection of treatment approach, 759
Re-evaluation following initial non-surgical
periodontal treatment, 760
Efficacy of repeated non-surgical pocket/root
instrumentation, 761
Part 12: Additional Therapy
39 Periodontal Surgery: Access Therapy, 767
Jan L. Wennstrôm and ]an Lindhe
Introduction, 767
Techniques in periodontal pocket surgery, 767
Gingivectomy procedures, 768
Flap procedures, 770
Modified Widman flap, 773
Regenerative procedures, 777
Distal wedge procedures, 778
Osseous surgery, 780
Osteoplasty, 780
Osteotomy, 781
General guidelines for periodontal surgery, 782
Objectives of surgical treatment, 782
Indications for surgical treatment, 782
Contraindications for periodontal surgery, 783
Local anesthesia in periodontal surgery, 783
XIV
Contents
Instruments used in periodontal surgery, 785
Selection of surgical technique, 788
Root surface instrumentation, 790
Root surface conditioning/biomodification, 791
Suturing, 791
Periodontal dressings, 792
Postoperative pain control, 794
Post-surgical care, 794
Outcome of surgical periodontal therapy, 795
Healing following surgical pocket therapy, 795
Clinical outcome of surgical access therapy in
comparison to non-surgical therapy, 796
40 Treatment of Furcation-Involved Teeth, 805
Gianfranco Carnevale, Roberto Pontoriero,
and Jan Lindhe
Terminology, 805
Anatomy, 806
Maxillary molars, 806
Maxillary premolars, 807
Mandibular molars, 807
Other teeth, 808
Diagnosis, 808
Probing, 810
Radiographs, 810
Differential diagnosis, 811
Trauma from occlusion, 811
Therapy, 812
Scaling and root planing, 812
Furcation plasty, 812
Tunnel preparation, 814
Root separation and resection, 814
Regeneration of furcation defects, 822
Extraction, 825
Prognosis, 825
Conclusion, 828
41 Endodontics and Periodontics, 830
Gunnar Bergenholtz, Domenico Ridicci,
Beatrice Siegrist-Giridener, and Matthias Zelmder
Introduction, 830
Infectious processes of endodontic origin in the
periodontium, 831
General features, 831
Clinical presentations, 832
Distinguishing lesions of endodontic origin from
periodontitis, 834
Endo-perio lesions: Diagnosis and treatment
aspects, 838
Endodontic treatment and periodontal
lesions, 840
Iatrogenic root perforations, 841
Occurrence, 841
Diagnosis, 841
Treatment approaches, 841
Vertical root fractures, 843
Mechanisms, 843
Occurrence, 844
Clinical signs and symptoms, 845
Diagnosis, 848
Treatment considerations, 849
Cementai tears, 849
Diagnosis and treatment, 849
Root malformations, 850
Diagnosis, 850
Treatment considerations, 850
Root surface resorptions, 850
Cervical invasive root resorptions, 851
42 Treatment of Peri-implant Mucositis
and Peri-implantitis, 861
Tord Berglundh, Niklaus P. Lang, and ¡an Lindhe
Introduction, 861
Treatment strategies, 861
Non-surgical therapy, 861
Surgical therapy, 862
Implant surface decontamination, 864
Reconstructive procedures, 865
Re-osseointegration, 865
Conclusion, 868
43 Antibiotics in Periodontal Therapy, 870
Andrea Mombelli and David Herrera
Introduction, 870
Principles of antibiotic use in periodontics, 871
Is periodontitis an infection and should it be
treated as one?, 871
Specific characteristics of the periodontal
infection, 871
Should antimicrobial therapy be aimed at specific
pathogens?, 872
Drug delivery routes, 872
Systemic antibiotics, 873
Combination antimicrobial drug therapy, 875
Adverse reactions, 876
Systemic antimicrobial therapy in
clinical trials, 876
Timing of systemic antibiotic therapy, 877
Selection of patients who may benefit most from
systemic antibiotics, 878
Minimizing the risk of the development of
antimicrobial antibiotic resistance, 880
Local antimicrobial therapy, 881
Local antimicrobial therapy in clinical trials, 881
Minocycline ointment and microspheres, 881
Doxycycline hyclate in a biodegradable
polymer, 882
Metronidazole gel, 882
Tetracycline in a non-resorbable plastic
co-polymer, 882
Azithromycin gel, 883
Chlorhexidine products, 883
Comparative evaluation of treatment
methods, 883
Local antibiotics in clinical practice, 884
Conclusion, 884
44 Local Drug Delivery for the Treatment
of Periodontitis, 891
Maurizio S. Tonetti and Pierpaolo Cortellini
Introduction, 891
Periodontal pharmacokinetics, 892
Pocket volume and clearance, 892
Development of periodontal local delivery
devices, 892
Antimicrobial effects of local delivery devices, 893
Efficacy of local delivery devices, 894
Clinical indications for treatment of periodontitis
with adjunctive local delivery devices, 896
Local conditions, 896
Special patient groups, 896
Conclusion, 897
Contents
XV
Part 13: Reconstructive Therapy
45 Regenerative Periodontal Therapy, 901
Pierpaolo Cartellini and Maurizio S. Tonetti
Introduction, 901
Classification and diagnosis of periodontal osseous
defects, 901
Clinical indications, 903
Long-term effects and benefits of regeneration, 903
Evidence for clinical efficacy and effectiveness, 908
Patient, defect, and tooth prognostic factors, 911
Patient factors, 912
Defect factors, 913
Tooth factors, 914
Factors affecting the clinical outcomes in
furcations, 915
Relevance of the surgical approach, 915
Surgical approach to intrabony defects, 918
Papilla preservation flaps, 918
Postoperative regimen, 934
Postoperative period and local side effects, 934
Surgical and post-surgical morbidity, 935
Barrier materials for regenerative surgery, 937
Non-bioresorbable materials, 937
Bioresorbable materials, 937
Membranes for intrabony defects, 938
Membranes for furcation involvement, 938
Bone replacement grafts, 943
Grafts for intrabony defects, 943
Grafts for furcation involvement, 945
Biologically active regenerative materials, 946
Growth factors for intrabony defects, 947
Growth factors for furcation involvement, 947
Enamel matrix derivatives for intrabony
defects, 948
Enamel matrix derivatives for furcation
involvement, 949
Combination therapy, 949
Combination therapy for intrabony defects, 949
Combination therapy for furcation
involvement, 953
Root surface biomodification, 954
Clinical potential and limits for regeneration, 954
Clinical strategies, 955
Clinical flowcharts, 957
Conclusion, 960
46 Mucogingival Therapy: Periodontal Plastic
Surgery, 969
Jan L. Wennström and Giovanni Zucchelli
Introduction, 969
Gingival augmentation, 970
Gingival dimensions and periodontal health, 970
Marginal tissue recession, 972
Marginal tissue recession and orthodontic
treatment, 975
Gingival dimensions and restorative therapy, 978
Indications for gingival augmentation, 979
Gingival augmentation procedures, 979
Healing following gingival augmentation
procedures, 981
Root coverage, 985
Root coverage procedures, 987
Selection of surgical procedure for root
coverage, 1001
Clinical outcome of root coverage
procedures, 1002
Soft tissue healing against the covered
root surface, 1007
Interdental papilla reconstruction, 1010
Surgical techniques, 1011
Crown-lengthening procedures, 1013
Excessive gingival display, 1013
Exposure of sound tooth structure, 1016
Ectopic tooth eruption, 1019
Deformed edentulous ridge, 1022
Prevention of soft tissue collapse following tooth
extraction, 1023
Correction of ridge defects by the use of soft
tissue grafts, 1025
Surgical procedures for ridge augmentation, 1025
47 Periodontal Plastic Microsurgery, 1043
Rino Burkhardt and Niklaus P. Lang
Microsurgical techniques in dentistry: development of
concepts, 1043
Concepts in microsurgery, 1044
Magnification, 1044
Instruments, 1049
Suture materials, 1049
Training concepts: Surgeons and assistants, 1052
Clinical indications and limitations, 1053
Comparison to conventional mucogingival
interventions, 1055
Part 14: Surgery for Implant Installation
48 Piezoelectric Surgery for Precise and Selective
Bone Cutting, 1063
Stefan Stiibinger and Niklaus P. Lang
Background and physical principles, 1063
Technical characteristics of piezoelectric bone
surgery, 1064
Application of piezosurgery, 1064
Clinical and biologic advantages of piezosurgery, 1065
Piezoelectric implant site preparation, 1067
Clinical applications of piezoelectric surgery, 1067
Sinus floor elevation, 1068
Bone grafting, 1069
Lateralization of the inferior alveolar nerve, 1069
Edentulous ridge splitting, 1070
Orthodontic microsurgery, 1070
Conclusion, 1071
49 Timing of Implant Placement, 1073
Christoph H.F. Hämmerle, Mauricio Araujo,
and Jan Lindhe
Introduction, 1073
Type 1 placement as part of the same surgical
procedure as and immediately following tooth
extraction, 1075
Ridge alterations in conjunction with implant
placement, 1075
Stability of implant, 1081
Type 2 placement: Completed soft tissue coverage
of the tooth socket, 1082
Type 3 placement: Substantial bone fill has occurred
in the extraction socket, 1083
Type 4 placement: Alveolar process is healed following
tooth loss, 1083
XVI
Contents
Clinical concepts, 1084
Aim of therapy, 1084
Success of treatment and long-term outcomes, 1086
Conclusion, 1086
Part 15: Reconstructive Ridge Therapy
50 Ridge Augmentation Procedures, 1091
Hector F. Rios, Fabio Vignoletti,
William V Giannobile, and Mariano Sanz
Introduction: Principles in alveolar bone
regeneration, 1091
Promoting primary wound closure, 1093
Enhancing cell proliferation and
differentiation, 1093
Protecting initial wound stability and
integrity, 1093
Treatment objectives, 1093
Diagnosis and treatment planning, 1094
Patient, 1094
Defect classification, 1094
Bone augmentation therapies, 1096
Biologic principles of guided bone regeneration, 1096
Regenerative materials, 1096
Barrier membranes, 1096
Bone grafts and bone substitutes, 1097
Evidence-based results for ridge augmentation
procedures, 1099
Ridge preservation, 1099
Bone regeneration in fresh extraction sockets, 1099
Horizontal ridge augmentation, 1101
Ridge splitting/expansion, 1103
Vertical ridge augmentation, 1103
Emerging technologies, 1105
Growth factors, 1105
Cell therapy, 1106
Scaffolding matrices to deliver cells and genes, 1106
Future perspective, 1108
Conclusion, 1109
Acknowledgments, 1109
51 Elevation of the Maxillary Sinus Floor, 1115
Bjarni E. Pjetursson and Niklans P Lang
Introduction, 1115
Treatment options in the posterior maxilla, 1116
Sinus floor elevation with a lateral approach, 1117
Anatomy of the maxillary sinus, 1117
Presurgical examination, 1118
Indications and contraindications, 1118
Surgical techniques, 1118
Post-surgical care, 1122
Complications, 1122
Grafting materials, 1123
Success and implant survival, 1125
Sinus floor elevation with the transalveolar approach
(osteotome technique), 1128
Indications and contraindications, 1128
Surgical technique, 1128
Post-surgical care, 1132
Complications, 1133
Grafting material, 1133
Success and implant survival, 1134
Short implants, 1134
Conclusion and clinical suggestions, 1136
Part 16: Occlusal and Prosthetic Therapy
52 Tooth-Supported Fixed Dental Prostheses, 1143
Jan Lindhe and Sture Nyman
Clinical symptoms of trauma from occlusion, 1143
Angular bony defects, 1143
Increased tooth mobility, 1143
Progressive (increasing) tooth mobility, 1143
Tooth mobility crown excursion /root displacement, 1143
Initial and secondary tooth mobility, 1143
Clinical assessment of tooth mobility (physiologic
and pathologic tooth mobility), 1145
Treatment of increased tooth mobility, 1146
Situation 1, 1146
Situation 2, 1147
Situation 3, 1147
Situation 4, 1150
Situation 5, 1152
53 Implants in Restorative Dentistry, 1156
Niklaus P. Lang and Giovanni E. Salvi
Introduction, 1156
Treatment concepts, 1156
Limited treatment goals, 1157
Shortened dental arch concept, 1157
Indications for implants, 1158
Increase of subjective chewing comfort, 1158
Preservation of intact teeth or reconstructions, 1159
Replacement of strategically important missing
teeth, 1160
Conclusion, 1163
54 Implants in the Zone of Esthetic Priority, 1165
Ronald E. Jung and Rino Burkhardt
Introduction, 1165
Importance of esthetics in implantology and its
impact on patient quality of life, 1165
Decision-making process and informed
consent, 1166
Preoperative diagnostics and risk analysis, 1167
Clinical measurements, 1167
Image-guided diagnostics, 1168
Visualization of prospective results for diagnostics
and to inform patients, 1168
Checklists and risk assessment (indications
and contraindications), 1169
Provisional restorations and timing of the treatment
sequences, 1172
Phase 1: From tooth extraction to implant
placement, 1172
Phase 2: From implant placement to abutment
connection, 1175
Phase 3: From abutment connection to final
crown/bridge placement, 1177
Surgical considerations when dealing with implants
in the zone of esthetic priority, 1179
Surgical aspects for an undisturbed wound
healing, 1179
Incisions and flap designs, 1180
Clinical concepts for a single missing tooth, 1182
Sites with no or minor tissue deficiencies, 1182
Sites with extended or severe tissue
deficiencies, 1182
Clinical concepts for multiple missing teeth, 1185
Sites with minor tissue deficiencies, 1190
Contents xvii
Sites with extended tissue deficiencies, 1190
Sites with severe tissue deficiencies, 1196
Prosthetic reconstruction in the zone of esthetic
priority, 1201
Screw-retained versus cemented
reconstructions, 1201
Standardized prefabricated versus customized
abutments, 1207
Porcelain-fused-to-metal versus all-ceramic
abutments, 1208
Esthetic failures, 1209
Classification of esthetic failures, 1210
Recommendations for retreatment of esthetic
failures, 1210
Concluding remarks and perspectives, 1213
55 Implants in the Posterior Dentition, 1218
Ronald E. Jung, Daniel S. Thoma, and Urs C. Belser
Introduction, 1218
Indications for implants in the posterior dentition, 1219
Controversial issues, 1221
General considerations and decision-making for
implants in the posterior dentition, 1221
Decision-making between implant-supported
reconstruction and tooth-supported fixed dental
prostheses, 1221
Implant restorations with cantilever units, 1223
Combination of implant and natural tooth
support, 1224
Splinted versus single-unit restorations of multiple
adjacent posterior implants, 1225
Longest possible versus shorter implants,
including impact of crown-to-implant ratio, 1226
Implants in sites with extended vertical bone
volume deficiencies, 1227
Preoperative diagnostics and provisional
reconstructions in the posterior dentition, 1233
Preoperative prosthetic diagnostics, 1233
Three-dimensional radiographic diagnostics
and planning, 1233
Clinical concepts for the restoration of free-end situations
with fixed implant-supported prostheses, 1235
Number, size, and distribution of implants, 1235
Clinical concepts for multiunit tooth-bound posterior
implant restorations, 1238
Number, size, and distribution of implants, 1238
Clinical concepts for posterior single-tooth
replacement, 1241
Premolar-size single-tooth restorations, 1241
Molar-size single-tooth restorations, 1244
Prosthetic reconstructions in the posterior dentition, 1245
Loading concepts for the posterior dentition, 1245
Screw-retained versus cemented
reconstructions, 1247
Selection criteria for choice of restorative materials
(abutments/crowns), 1248
Concluding remarks and perspectives, 1254
Acknowledgments, 1254
56 Role of Implant-Implant- and Tooth-Implant-
Supported Fixed Partial Dentures, 1262
Clark M. Stanford and Lyndon F. Cooper
Introduction, 1262
Patient assessment, 1262
Implant treatment planning for the edentulous arch, 1264
Prosthesis design and full-arch tooth replacement
therapy, 1264
Complete-arch fixed complete dentures, 1264
Prosthesis design and partially edentulous tooth
replacement therapy, 1265
Cantilever pontics, 1267
Immediate provisionalization, 1269
Disadvantages of implant-implant fixed partial
dentures, 1269
Tooth-implant fixed partial dentures, 1270
Conclusion, 1272
57 Complications Related to Implant-Supported
Restorations, 1276
Clark M. Stanford, Lyndon F. Cooper,
and Y. Joon Coe
Introduction, 1276
Clinical complications in conventional fixed
restorations, 1276
Clinical complications in implant-supported
restorations, 1278
Biologic complications, 1278
Mechanical complications, 1281
Other issues related to prosthetic complications, 1286
Implant angulation and prosthetic
complications, 1286
Screw-retained versus cement-retained
restorations, 1287
Ceramic abutments, 1288
Esthetic complications, 1288
Success/survival rate of implant-supported
prostheses, 1290
Conclusion, 1290
Part 17: Orthodontics and Periodontics
58 Tooth Movement in the Periodontally
Compromised Patient, 1297
Mariano Sanz and Coiichita Martin
Introduction: Biologic principles of orthodontic tooth
movement, 1297
Periodontal and orthodontic diagnosis, 1298
Treatment planning, 1300
Periodontal considerations, 1300
Orthodontic considerations, 1301
Orthodontic treatment, 1305
Specific orthodontic tooth movements, 1305
Extrusion movements, 1305
Molar uprighting, 1308
Orthodontic tooth movements through
cortical bone, 1308
Intrusive tooth movements, 1311
Orthodontic tooth movements and periodontal
regeneration, 1316
Pathologic tooth migration, 1320
Multidisciplinary treatment of esthetic problems, 1321
59 Implants Used for Orthodontic
Anchorage, 1325
Marc A. Schdtzle and Niklaus P. Lang
Introduction, 1325
Evolution of implants for orthodontic anchorage, 1326
Prosthetic implants for orthodontic anchorage, 1326
Bone reaction to orthodontic implant loading, 1327
xviii Contents
Indications for prosthetic oral implants
for orthodontic anchorage, 1329
Prosthetic oral implant anchorage in growing
orthodontic patients, 1329
Orthodontic implants as temporary anchorage
devices, 1332
Implant designs and dimensions, 1332
Insertion sites for palatal implants, 1333
Palatal implants and their possible effects
in growing patients, 1334
Clinical procedures and loading time schedule
for palatal implant installation, 1336
Direct or indirect orthodontic implant
anchorage, 1338
Stability and success rates, 1339
Implant removal, 1339
Advantages and disadvantages, 1340
Conclusion, 1341
Part 18: Supportive Care
60 Supportive Periodontal Therapy, 1347
Niklaus P. Lang, Giedrė Matulienė,
Giovanni E. Salvi, and Maurizio S. Tonetti
Definition, 1347
Basic paradigms for the prevention of periodontal
disease, 1348
Patients at risk for periodontitis without supportive
periodontal therapy, 1350
Supportive periodontal therapy for patients with
gingivitis, 1351
Supportive periodontal therapy for patients with
periodontitis, 1352
Continuous multilevel risk assessment, 1353
Subject periodontal risk assessment, 1354
Calculating the patient s individual periodontal
risk assessment, 1359
Tooth risk assessment, 1359
Site risk assessment, 1361
Radiographic evaluation of periodontal disease
progression, 1362
Clinical implementation, 1362
Objectives for supportive periodontal
therapy, 1363
Supportive periodontal therapy in daily
practice, 1364
Examination, re-evaluation, and
diagnosis, 1364
Motivation, re-instruction, and
instrumentation, 1365
Treatment of re-infected sites, 1366
Polishing, fluorides, and determination of recall
interval, 1366
Index, il
|
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| spelling | Clinical periodontology and implant dentistry 1 Basic concepts ed. by Niklaus P. Lang ; Jan Lindhe 6. ed. Oxford [u.a.] Blackwell, Munksgaard 2015 Oxford [u.a.] Wiley Blackwell 2015 XXIII, 555, 26 S. zahlr. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Lang, Niklaus P. 1942- (DE-588)172216982 edt Lindhe, Jan Sonstige oth (DE-604)BV023362970 1 Digitalisierung UB Regensburg - ADAM Catalogue Enrichment application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=028123156&sequence=000003&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Klappentext Digitalisierung UB Regensburg - ADAM Catalogue Enrichment application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=028123156&sequence=000004&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Clinical periodontology and implant dentistry |
| title | Clinical periodontology and implant dentistry |
| title_auth | Clinical periodontology and implant dentistry |
| title_exact_search | Clinical periodontology and implant dentistry |
| title_full | Clinical periodontology and implant dentistry 1 Basic concepts ed. by Niklaus P. Lang ; Jan Lindhe |
| title_fullStr | Clinical periodontology and implant dentistry 1 Basic concepts ed. by Niklaus P. Lang ; Jan Lindhe |
| title_full_unstemmed | Clinical periodontology and implant dentistry 1 Basic concepts ed. by Niklaus P. Lang ; Jan Lindhe |
| title_short | Clinical periodontology and implant dentistry |
| title_sort | clinical periodontology and implant dentistry basic concepts |
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