Practical Periodontal Diagnosis and Treatment Planning

188 Pages·2010·12.374 MB·English

by  Serge Dibart, Thomas Dietrich

PRACTICAL PERIODONTAL DIAGNOSIS AND
TREATMENT PLANNING
Serge Dibart, DMD
Professor and Director of Post-Graduate Program of Periodontology and Oral Biology
Boston University School of Dental Medicine
Thomas Dietrich, MD, DMD, M.P.H.
Professor and Head of Oral Surgery
The School of Dentistry, University of Birmingham

A John Wiley & Sons, Ltd., Publication

PRACTICAL PERIODONTAL DIAGNOSIS AND
TREATMENT PLANNING

PRACTICAL PERIODONTAL DIAGNOSIS AND
TREATMENT PLANNING
Serge Dibart, DMD
Professor and Director of Post-Graduate Program of Periodontology and Oral Biology
Boston University School of Dental Medicine
Thomas Dietrich, MD, DMD, M.P.H.
Professor and Head of Oral Surgery
The School of Dentistry, University of Birmingham

A John Wiley & Sons, Ltd., Publication
Edition fi rst published 2010 A catalog record for this book is available from the U.S.
© 2010 Blackwell Publishing Library of Congress.
Blackwell Publishing was acquired by John Wiley & Sons in
Set in 9.5 on 12 pt Helvetica Light by SNP Best-set
February 2007. Blackwell’s publishing program has been
Typesetter Ltd., Hong Kong
merged with Wiley’s global Scientifi c, Technical, and
Printed in Singapore
Medical business to form Wiley-Blackwell.
Disclaimer
Editorial Offi ce
The contents of this work are intended to further general
2121 State Avenue, Ames, Iowa 50014-8300, USA
scientifi c research, understanding, and discussion only and
For details of our global editorial offi ces, for customer are not intended and should not be relied upon as
services, and for information about how to apply for recommending or promoting a specifi c method, diagnosis,
permission to reuse the copyright material in this book, or treatment by practitioners for any particular patient. The
please see our website at www.wiley.com/wiley-blackwell. publisher and the author make no representations or
warranties with respect to the accuracy or completeness of
Authorization to photocopy items for internal or personal
the contents of this work and specifi cally disclaim all
use, or the internal or personal use of specifi c clients, is
warranties, including without limitation any implied
granted by Blackwell Publishing, provided that the base fee
warranties of fi tness for a particular purpose. In view of
is paid directly to the Copyright Clearance Center, 222
ongoing research, equipment modifi cations, changes in
Rosewood Drive, Danvers, MA 01923. For those
governmental regulations, and the constant fl ow of
organizations that have been granted a photocopy license
information relating to the use of medicines, equipment,
by CCC, a separate system of payments has been
and devices, the reader is urged to review and evaluate the
arranged. The fee codes for users of the Transactional
information provided in the package insert or instructions
Reporting Service are ISBN-13: 978-0-8138-1184-0/2010.
for each medicine, equipment, or device for, among other
things, any changes in the instructions or indication of
Designations used by companies to distinguish their
usage and for added warnings and precautions. Readers
products are often claimed as trademarks. All brand names
should consult with a specialist where appropriate. The fact
and product names used in this book are trade names,
that an organization or Website is referred to in this work
service marks, trademarks or registered trademarks of their
as a citation and/or a potential source of further information
respective owners. The publisher is not associated with
does not mean that the author or the publisher endorses
any product or vendor mentioned in this book. This
the information the organization or Website may provide or
publication is designed to provide accurate and
recommendations it may make. Further, readers should be
authoritative information in regard to the subject matter
aware that Internet Websites listed in this work may have
covered. It is sold on the understanding that the publisher
changed or disappeared between when this work was
is not engaged in rendering professional services. If
written and when it is read. No warranty may be created or
professional advice or other expert assistance is required,
extended by any promotional statements for this work.
the services of a competent professional should be sought.
Neither the publisher nor the author shall be liable for any
Library of Congress Cataloging-in-Publication Data damages arising herefrom.
Practical periodontal diagnosis and treatment planning /
1 2010
[edited by] Serge Dibart, Thomas Dietrich.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-8138-1184-0 (alk. paper)
ISBN-10: 0-8138-1184-8 (alk. paper)
1. Periodontal disease. I. Dibart, Serge. II. Dietrich,
Thomas, 1969-
[DNLM: 1. Periodontal Diseases–diagnosis.
2. Periodontal Diseases–therapy. 3. Evidence-Based
Dentistry–methods. 4. Patient Care Planning.
WU 240 P895 2010]
RK361.P734 2010
617.6´32–dc22
2009023103
IN MEMORY OF DR. SHEILESH DAVE
September 3, 1967– March 7, 2009
Dr. Sheilesh Dave’ s dental career began after he graduated periodontics, always trying to be on the cutting edge of his
from the Faculty of Dentistry, University of Alberta, in 1992. work, and for being a kind, warm, funny person. Apart from
He practiced in Calgary, Alberta, for 10 years, and then took his career, Sheilesh was an accomplished pianist, having
his ambitions to Boston University, where he attended the studied seriously both classical and jazz; he could be heard
Faculty of Periodontics, graduating from BU ’s periodontal playing with a jazz combo on Tuesday evenings. He was
program in 2004. For him periodontology was a s pecialty that fi nally on the cusp of enjoying the fruits of his labor, enjoying
provided the right mix of manual skill and intellectual prowess. his family and life, when a tragic accident suddenly took him
He proved to be an excellent, studied surgeon and enjoyed from us.
the academic underpinnings of our profession. He was an
outstanding student, well respected by his fellow graduates Sheilesh’ s premature departure leaves behind his loving
and the faculty and staff at Boston University. Following his parents and his lovely wife and their two children, a son and
graduation, Sheilesh returned to his roots, and set up a thriv- a daughter. He also leaves behind his sister and her husband
ing practice in Calgary. and their two children.
Always challenging himself, never content with the status quo He will be remembered for his kind, gentle, generous, loving,
was the key to his success. In his sadly short career Sheilesh spirited soul, and for being a most authentic and special
earned a reputation among his colleagues for his honed skills person. He walks among the daffodils now.
as a periodontist, for always pursuing the academic side of

Contents
Contributor List ix Occlusal Concepts for Conventional Fixed
Prosthodontics 57
Chapter 1. The Necessity of an Evidence- Anterior Disclusion (Canine Disclusion) and
based Approach to Diagnosis Group Function 58
and Treatment 3 Splinting 59
Paul Farsai and Thomas Van Dyke Implant-supported Artifi cial Occlusion 60
Problems with Introducing EBD 5 Articulators 64
Advantages of EBD 5 Authors’ Views/Comments 65
Chapter 2. Classifi cation of Periodontal
Chapter 6. Systemic and Local Drug
Diseases and Conditions 7
Delivery of Antimicrobials 69
Serge Dibart and Melanie Campese
Dimitra Sakellari
I. Gingival Diseases 7
Evidence-based Outcomes 69
II. Chronic Periodontitis (Discarded
Indications 72
Old Terminology: Adult
Techniques 72
Periodontitis) 14
Author’s Views/Comments 74
III. Aggressive Periodontitis
(Discarded Old Terminology:
Chapter 7. Periodontal Osseous Resective
Early Onset Periodontitis) 15
Surgery 77
IV. Periodontitis as a Manifestation of
Luca Landi
Systemic Diseases 18
Indications and Endpoints 77
V. Necrotizing Periodontal Disease 19
Physiologic and Pathologic Alveolar
VI. Periodontal Abscess 20
Bone Anatomy 77
VII. Periodontitis Associated with
Principles 79
Endodontic Lesion 21
Technique 80
VIII. Developmental or Acquired
Modifi cations to the Original Surgical
Deformities and Conditions 22
Approach 83
Soft Tissue Management 85
Chapter 3. Periodontal Risk Factors and
Effect of Surgery on the Alveolar Bone 86
Modifi cation 25
Clemens Walter, Christoph Ramse ier, Evidence-based Outcomes 87
Author’s Views/Comments 97
and Thomas Dietrich
Non-modifi able Risk Factors 25
Modifi able Risk Factors 27 Chapter 8. Regenerative Periodontal Therapy 99
Risk Factor Modifi cation 32 Joseph Fiorellini and Mehmet Ilhan Uzel
Periodontal Regenerative Techniques 100
Chapter 4. Scaling and Root Planing 43 Future of Periodontal Regenerative
Rahman Kohli Therapy 105
Instrumentation 43 Future Regenerative Therapy with
Scaling and Root Planing 46 rhPDGF 109
Root Surface Smoothness 49
Full-Mouth Debridement 49 Chapter 9. Surgical vs. Non-surgical
Practical Aspects 50 Treatment of Periodontitis 115
Thomas Dietrich
Chapter 5. Occlusion 55 Evidence-based Outcomes 115
Steven Morgano, Adnan Ishgi, Author’s Views/Comments 115
and Carlos Sabrosa
Centric Relation and Centric Chapter 10. Supportive Periodontal Therapy 121
Occlusion 55 Geoff Bateman
Balanced Articulation 55 Indications 121
vii
ffttoocc..iinndddd vviiii 99//2299//22000099 33::2299::4422 PPMM
Technique 121 Appendix 1. A Little Slice of History: The
Evidence-based Outcomes 123 Periodontal Condition of Napoleon’s
Author’s Views/Comments 125 Grand Army: A Forensic Evaluation 137
Yves Macia
Chapter 11. Dental Implants Therapy 127
Serge Dibart Appendix 2. How to Write and Read a Scientifi c
Indications 127 Paper 147
Evidence-based Outcomes 127 Cataldo Leone
Chapter 12. Infl ammation and Bone Healing Index 165
Around Dental Implants 131
Thomas Van Dyke and Sheilesh Dave
Bone Function and Structure 131
Bone Healing Following Implant
Placement 132
Infl ammatory Bone Loss Around the
Integrated Implant 133

viii Contents