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PracticalTechniquesinPeriodonticsandImplantDentistry
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Practical Techniques in Periodontics and Implant Dentistry
Edited by
EdgardElChaar,DDS,MS
DepartmentofPeriodontics
UniversityofPennsylvania,DentalMedicine
Philadelphia,PA,USA
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Thiseditionfirstpublished2023
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v
Contents
ListofContributors xiii
Introduction xv
PartI Fundamentals 1
1 AnatomyandPhysiology 3
EdgardElChaarandThierryAbitbol
OverviewofGingivalTissueandPeriodontium 3
EmbryonicDevelopment 3
FormationoftheEpithelialAttachment 4
FormationoftheCementum,PeriodontalLigament,andAlveolarBone 4
SoftTissuePhysiology 6
(cid:2) Gingiva 6 (cid:2)
WidthandThicknessoftheGingiva 6
HistologicalComposition 6
Epithelial–ConnectiveTissueInteraction 7
GingivalFiberGroups 7
AlveolarMucosa 7
JunctionalEpithelium 8
Biotype 8
PeriodontalBiotype 8
AnatomyIsDestiny 9
Anatomy 9
RootSurfaceAnatomy 9
AnteriorTeeth 10
DevelopmentalAnteriorGrooves 10
Premolars 10
TheRootTrunk 11
MaxillaryFirstMolars 11
MandibularFirstMolars 11
CervicalEnamelProjections(CEPs) 12
References 12
FurtherReading 13
2 WoundHealing 14
StevenEngebretson
DefinitionsandTermsforClinicalOutcomes 14
InflammatoryPhase 14
ProliferativePhase 14
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RemodelingPhase 15
EpitheliumandConnectiveTissueHealing 15
FlapSurgery 15
FreeGraft 15
BoneHealing 15
HealingofExtractionSockets 16
Osseointegration 16
ModifiersofWoundHealing 16
References 17
3 DiagnosisandPathologyofPeriodontalDiseases 18
CeciliaWhite
FormulatingaPeriodontalDiagnosis 18
PeriodontalHealthandGingivalHealth 18
Gingivitis:DentalPlaque-Induced 19
NecrotizingPeriodontalDiseases 19
Periodontitis 19
OtherConditionsAffectingthePeriodontium 20
PeriodontalAbscesses 20
Endodontic–PeriodontalLesions 20
MucogingivalDeformitiesandConditionsAroundtheTeeth 20
TraumaticOcclusalForces 20
ProsthesisandTooth-RelatedFactors 20
References 21
(cid:2) 4 OralPathologyandOralMedicine 22 (cid:2)
EdgardElChaarandArthiM.Kumar
Introduction 22
Non-Dental-BiofilmInducedGingivalDiseases 22
Genetic/DevelopmentalDisorders 22
HereditaryGingivalFibromatosis(HGF) 22
SpecificInfections 22
InfectionsofBacterialOrigin 22
InfectionsofViralOrigin 24
InfectionsofFungalOrigin 25
InflammatoryandImmuneConditions 27
HypersensitivityReactions 27
AutoimmuneDiseasesofSkinandMucousMembranes 27
GranulomatousInflammatoryConditions 30
ReactiveProcesses 31
Epulides 31
Pre-MalignantLesionsandMalignantNeoplasms 32
Endocrine,Nutritional,andMetabolicDiseases 34
TraumaticLesions 34
Physical/MechanicalInsults 34
Chemical/ThermalInsults 36
GingivalPigmentation 36
Endocrine,Nutritional,andMetabolicDiseases 38
GeneticDisorders 38
DiseasesAffectingtheConnectiveTissues 39
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Contents vii
AcquiredImmunodeficiencyDiseases 41
InflammatoryDiseases 41
SystemicDisordersthatInfluencethePathogenesisofPeriodontalDisease 41
FurtherReading 44
5 PatientExaminationandInitialTherapy 50
ClaireMcCarthy,SteveEngeberston,EdgardElChaar,MeaWeinberg,StuartL.Segelnick,andDenaM.Sapanaro
MedicalHistoryfortheDentalPatient 50
ClinicalandRadiographicalExamination 50
ClinicalExamination 50
RadiographicExamination 51
RadiographicArtifacts 51
OralHygiene 51
Toothbrushing 52
InterproximalCleaning 52
InterproximalBrushes 52
DentalFlossorTape 52
SpecializedOralHygieneAids 53
SingleTuftedBrush 53
BehaviorChangeTechniques 53
Non-surgicalPeriodontalTherapy 54
Benefits 54
Limitations 54
Armamentarium 54
HandInstruments 54
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Techniques 55
SupragingivalDebridement 55
FundamentalElementsofHandInstrumentation 55
CalculusDetectionTechnique 55
Fulcrums 56
Powered(Ultrasonic)Technique 56
ReevaluationofInitialTherapy 56
OcclusalTherapy 56
MedicationsandImplicationsforPeriodontalTherapy 57
Sedation:MinimalandModerateSedation 57
References 58
FurtherReading 58
PartII PrinciplesandPracticeofPeriodontalSurgery 61
6 SurgicalAnatomyandLocalAnesthesia 63
RoyaAfshar-MohajerandBabakHamidi
AnatomicLandmarks 63
Mandible 63
AnatomicSpaces 65
Maxilla 65
Conclusion 67
PropertiesofLocalAnesthesia 67
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PropertiesofIdealAnesthetic 68
TechniquesofLocalAnesthesia 68
MaxillaryAnesthesia 68
MandibularAnesthesia 68
FurtherReading 69
7 SuturingTechniques 70
MeaA.Weinberg,StuartL.Segelnick,andEdgardElChaar
PrinciplesofSurgicalWoundClosure 70
PropertiesofSutureMaterials 70
SuturingTechniquesandIndicationsforUse 72
References 76
8 OsseousSurgery 77
ThierryAbitbol
Introduction 77
OsseousSurgery 77
LimitationsandContraindicationstoOsseousResectiveSurgery 78
References 78
9 FunctionalCrownLengthening 79
ThierryAbitbol
Introduction 79
Checklist 79
OsseousSurgery 80
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10 RootAmputation 83
WayneKye
Overview 83
Terminology 83
IndicationsandContraindications 84
IndicationsInclude 84
ContraindicationsInclude 84
AdvantagesandDisadvantages 85
Armamentarium 85
SurgicalTechnique 85
Complications 86
OutcomeandFollow-up 86
ImplantsVersusRootResection 87
VitalRootResection 87
References 88
FurtherReading 89
11 GuidedTissueRegeneration 90
EdgardElChaarandMichaelBral
Overview 90
Indications 91
RepairandRegenerationinPeriodontalDefects 91
GTRforFurcationDefects 91
Technique 91
GTRforPeriodontalIntrabonyandCircumferentialDefects 93
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