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(cid:2) PracticalTechniquesinPeriodonticsandImplantDentistry (cid:2) (cid:2) (cid:2) (cid:2) (cid:2) (cid:2) (cid:2) (cid:2) Practical Techniques in Periodontics and Implant Dentistry Edited by EdgardElChaar,DDS,MS DepartmentofPeriodontics UniversityofPennsylvania,DentalMedicine Philadelphia,PA,USA (cid:2) (cid:2) (cid:2) (cid:2) Thiseditionfirstpublished2023 ©2023JohnWiley&SonsInc. Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,ortransmitted,inanyformorbyanymeans, electronic,mechanical,photocopying,recordingorotherwise,exceptaspermittedbylaw.Adviceonhowtoobtainpermissiontoreusematerial fromthistitleisavailableathttp://www.wiley.com/go/permissions. TherightofEdgardElChaartobeidentifiedastheauthoroftheeditorialmaterialinthisworkhasbeenassertedinaccordancewithlaw. 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LibraryofCongressCataloging-in-PublicationDataappliedfor ISBN:9781119793557(hardback) CoverDesign:Wiley CoverImages:CourtesyofEdgardElChaar Setin9.5/12.5ptSTIXTwoTextbyStraive,Chennai,India (cid:2) (cid:2) 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 (cid:2) (cid:2) vi Contents 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 (cid:2) (cid:2) 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 (cid:2) PoweredInstruments 54 (cid:2) 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 (cid:2) (cid:2) viii Contents 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 (cid:2) References 81 (cid:2) 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 (cid:2)