Practical Advanced Periodontal Surgery

A fully updated second edition of this well-illustrated guide to advanced surgical procedures in periodontology 

Practical Advanced Periodontal Surgery, Second Edition is a step-by-step guide to cutting-edge surgical techniques and interdisciplinary treatment approaches in periodontology.  Written by leading experts in the field, the book provides solutions to complex daily dental challenges with innovative approaches to each treatment modality. Procedures are described in a practical and accessible style, highlighting complex and advanced procedures using a highly illustrated visual format.

This expanded edition includes three new chapters that cover IV sedation, digital technologies in clinical restorative dentistry, and advanced implant therapies in the esthetic zone post extraction. Well balanced and solidly grounded in the science, this reference work is an indispensable resource for the practitioner of advanced dentistry. This important guide: 

•    Offers an easy-to-use, practical step-by-step format

•    Contains clinical photographs that detail the surgical procedures presented

•    Reviews the most advanced techniques in periodontal surgery and their integration with digital treatment planning and workflow

•    Discusses the pros and cons for each procedure, as well as limitations and potential complications

•    Features video clips illustrating key points in the procedures described on a companion website

Written for periodontists, periodontal residents and general or restorative dentists, this revised edition of Practical Advanced Periodontal Surgery is a practical and complete clinical manual filled with illustrations for easy reference.

The Editor

Serge Dibart is Professor and Chair of the department of periodontology at Boston University's Henry M. Goldman School of Dental Medicine in Boston, Massachusetts, USA.

List of Contributors xi

Acknowledgments xiii

About the Companion Website xv

Introduction 1
Thomas Van Dyke

1 Conscious IV Sedation Utilizing Midazolam 3
Jess Liu

Introduction 3

Midazolam (Versed) 3

Armamentarium 4

Steps in IV Sedation 4

2. Bone Physiology and Metabolism 11
Jean‐Pierre Dibart

Bone Composition 11

Bone Types 11

Bone Formation 11

Bone Density Measuring Techniques 14

Implications for Dental Treatments 15

3. Anatomy of the Dental/Alveolar Structures and Wound Healing 19
Albert Price

Anatomic Review (Emphasis on Vascular Supply) 19

Vascular Supply: Macro and Micro 19

Blood Supply Within the Alveolar and Basal Bone of the Dental Arches 21

Microarchitecture of the Bone/Tooth Relationship and the Interface of Soft and Hard Connective Tissues 21

Anatomy and Vascular Supply of the Investing Soft Connective Tissues 25

Cementum 28

Antatomy and Vascular Supply of the Epithelial Structures 28

The Wound‐Healing Process 29

4. Piezocision^TM Assisted Orthodontics in Everyday Practice 35
Serge Dibart, Elif Keser, and Donald Nelson

Introduction 35

The Technique 35

Computer Guided Piezocision‐Orthodontics 35

Dynamically Guided Piezocision 37

Piezocision Assisted Orthodontics With Clear Aligners 38

Incorporating Piezocision in Multidisciplinary Treatment 39

Post‐Operative Care 41

Contraindications for Piezocision 42

Potential Complications 42

5. The Contribution of Periodontics to Endodontic Therapy: The Surgical Management of Periradicular Periodontitis 43
Mani Moulazadeh

History and Evolution 43

Tooth Conservation Versus Implants 43

Treatment of Failed Root Canal Therapy 44

Rationale for Endodontic Surgery 44

Indications for Endodontic Surgery 44

Contraindications for Endodontic Surgery 46

Types of Endodontic Surgery 48

Periradicular Surgery 51

Phases of Apicoectomy and Surgical Technique 52

Recall 60

6. The Contribution of Periodontics to Prosthodontics: Treatment Planning of Patients Requiring Combined Periodontal and Prosthodontic Care 61
Haneen N. Bokhadoor, Nawaf J. Al‐Dousari, and Steven Morgano

Introduction 61

Diagnostic Phase (Data Collection) 61

Treatment-Planning Phase 63

Final Prognosis 63

Conclusion 105

7. The Contribution of Periodontics to the Correction of Vertical Alveolar Ridge Deficiencies 107
Serge Dibart

Alveolar Distraction Osteogenesis Surgery 107

8. Papillary Construction After Dental Implant Therapy 117
Peyman Shahidi, Serge Dibart, and Yun Po Zhang

History 117

Indications 117

Contraindications 117

Armamentarium 117

Technique 117

Postoperative Instructions 119

Surgical Indexing 119

Possible Complications 119

Healing 119

9. Dental Implant Placement Including the Use of Short Implants 121
Albert Price and Ming Fang Su

History 121

Indications 123

Surgical Technique 123

Implant Placement 125

Site Preparation 125

The Fixture (Implant) Installation 130

Possible Problems and Complications 130

10. Periodontal Medicine Including Biopsy Techniques 137
Vikki Noonan and Sadru Kabani

Gingival Nodules 137

Parulis 137

Fibroma 137

Peripheral Ossifying Fibroma 137

Pyogenic Granuloma 138

Peripheral Giant Cell Granuloma 138

Diagnosis and Treatment of Reactive Gingival Nodules 139

Gingival Cyst of the Adult 139

Mucocele 139

Desquamative Gingivitis 140

Lichen Planus 140

Pemphigus Vulgaris 141

Mucous Membrane (Cicatricial) Pemphigoid 141

Diagnosis and Treatment of Desquamative Gingival Lesions 142

Plasma Cell Gingivitis 142

Erythema Multiforme 143

Gingival Enlargement 144

Epulis Fissuratum 144

Medication‐Induced Gingival Overgrowth 144

Hyperplastic Gingivitis 144

Leukemia 145

Gingival Fibromatosis 145

Ligneous Gingivitis and Conjunctivitis 145

Wegener’s Granulomatosis 146

Pigmented Lesions 146

Physiologic Pigmentation 146

Medication‐Induced Pigmentation 146

Smoker’s Melanosis 147

Amalgam Tattoo 147

Melanotic Macule 148

Oral Melanoacanthoma (Melanoacanthosis) 148

Oral Melanocytic Nevus 148

Oral Melanoma 149

Sanguinaria‐Induced Leukoplakia 149

Proliferative Verrucous Leukoplakia 149

Malignant Neoplasia 150

Squamous Cell Carcinoma 150

Verrucous Carcinoma 151

Metastatic Disease 151

Infections 152

Herpes 152

HIV‐Associated Gingivitis 152

Oral Soft Tissue Biopsy Techniques 153

Armamentarium 153

Incisional Scalpel Biopsy 153

Excisional Scalpel Biopsy 154

Biopsy Data Sheet 154

11. Sinus Augmentation Using Tissue‐Engineered Bone 159
Ulrike Schulze‐Späte, Luigi Montesani, and Lorenzo Montesani

History 159

Indications 159

Contraindications 160

Armamentarium 160

Sinus Augmentation Using Tissue-Engineered Bone Discs 160

Transplant Implantation Surgery (Sinus Augmentation Procedure Using Tissue-Engineered Bone Discs) 161

Sinus Lift Using Autogenous Mesenchymal Cells Processed Chairside 165

12. Extraction Site Management in the Esthetic Zone: Hard and Soft Tissue Reconstruction 169
Sherif Said

Introduction 169

The Influence of Tissue Volume on the Peri‐Implant “Pink” Esthetics 169

Tissue Volume Availability and Requirements 169

Pre‐Operative Implant Site Assessment 172

Tissue Augmentation at the Time of Tooth Extraction 175

Management of Class I Sockets 177

Armamentarium 177

Three‐Dimensional Implant Positioning 179

Selection of the Bone Graft Material 180

Rationale 181

Socket Seal 183

Autogenous Tissue for Concomitant Buccal Volume Augmentation and Socket Seal Procedures 186

Sub‐Epithelial Connective Tissue Graft 186

Compromised Sockets 192

Flapless Ridge Preservation 192

Ridge Preservation Utilizing Barrier Membranes 193

Esthetic Ridge Augmentation 194

Open Flap Approach for Extraction Site Management 197

Site Analysis and Classification 197

Surgical Phase 198

Suturing of the Graft 203

Stabilization of the Graft 205

Closure 205

Managing Implant Tissue Deficiencies 206

Conclusion 210

13. Digital Technologies in Clinical Restorative Dentistry 213
Vygandas Rutkūnas, Rokas Borusevičius, Agnė Gečiauskaitė, and Justinas Pletkus

From Conventional to Digital Technologies 213

Digital Solutions for Planning and Manufacturing of Teeth‐Supported Restorations 214

Digital Solutions for Planning and Manufacturing of Implant‐Supported Restorations 223

Future Perspectives 227

Index 233

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