Lindhe's Clinical Periodontology and Implant Dentistry. Volume I-II

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Discover the latest edition of the cornerstone reference on periodontology and implant dentistry that combines scholarship and science with practical clinical instruction The Seventh Edition of Lindhe's Clinical Periodontology and Implant Dentistry brings together a distinguished team of periodontal specialists and academics who deliver another must-have resource for students, researchers, and practitioners specializing in periodontal care and implant dentistry. Seamlessly integrating the foundational science behind periodontology with practical clinical protocols in two comprehensive volumes, the chapters cover anatomy, microbiology, occlusion trauma, pathology, tissue regeneration, treatment planning protocols, infection control, reconstructive therapy, occlusal and prosthetic therapy, and more. The Seventh Edition of Lindhe's Clinical Periodontology and Implant Dentistry: Provides an introduction to anatomy, including periodontal tissues, the edentulous ridge, the mucosa at teeth and implants, and osseointegration Discusses the epidemiology of periodontal and peri-implant diseases Explores the microbiology, including dental biofilms and calculus, periodontal infections, peri-implant infections, the pathogenesis of gingivitis and periodontitis, and the genetic susceptibility to periodontal disease Includes the latest perio- and peri-implant disease classifications Contains updated evidence-based preventive and treatment modalities for the treatment of periodontal and peri-implant diseases Features the latest evidence-based therapeutic alternatives on the use of dental implants to rehabilitate the lost dentition Perfect for postgraduate dental students, researchers, and practitioners specializing in periodontal care and implant dentistry, Lindhe's Clinical Periodontology and Implant Dentistry continues to be the cornerstone reference work on periodontology. Cover Volume I Title Page Copyright Page Contents Contributors Preface Part 1: Anatomy Chapter 1 Anatomy and Histology of Periodontal Tissues Introduction Gingiva Anatomy Histology Periodontal ligament Root cementum Bone of the alveolar process Macroscopic anatomy Microscopic anatomy Blood supply of the periodontium Lymphatic system of the periodontium Nerves of the periodontium Acknowledgment References and further reading Chapter 2 Bone as a Living Organ Introduction Development Intramembranous bone formation Endochondral bone formation Structure Osseous tissue Matrix Periosteal tissue Bone marrow Function Mechanical properties Metabolic properties Skeletal homeostasis Healing Disorders Conclusion Acknowledgments References Chapter 3 The Edentulous Ridge Clinical considerations Remaining bone in the edentulous ridge Classification of remaining bone Topography of the alveolar process From an alveolar process to an edentulous ridge Intra-alveolar processes Extra-alveolar processes Topography of the edentulous ridge: summary References Chapter 4 The Mucosa at Teeth and Implants Gingiva Dimensions of the supracrestal attachment Dimensions of the buccal tissue Dimensions of the interdental papilla Peri-implant mucosa Dimensions of the supracrestal attachment Structure and composition Vascular supply Probing gingiva and peri-implant mucosa Dimensions of the buccal soft tissue at implants Dimensions of the papilla between teeth and implants Dimensions of the “papilla” between adjacent implants References Chapter 5 Osseointegration Introduction Implant installation Tissue injury Wound healing Cutting and non-cutting implants Process of osseointegration Morphogenesis of osseointegration Overall pattern of implant integration Biopsy sample observations References Part 2: Epidemiology Chapter 6 Epidemiology of Periodontitis Introduction Methodological issues Examination methods: index systems Assessment of inflammation of the periodontal tissues Assessment of loss of periodontal tissue support Radiographic assessment of alveolar bone loss Assessment of periodontal treatment needs Periodontitis “case definition” in epidemiologic studies Prevalence of periodontitis Periodontitis in adults Periodontitis in children and adolescents Periodontitis and tooth loss Risk factors for periodontitis Introduction: definitions Measures of disease occurrence Measures of association Causal inference and causal models Non-modifiable background factors Environmental, acquired, and behavioral factors Concluding remarks References Chapter 7 Epidemiology of Peri-Implant Diseases Introduction Disease definition Case definition Peri-implant health Peri-implant mucositis Peri-implantitis Examination methods Prevalence of peri-implant diseases Extent and severity of peri-implantitis Peri-implantitis and implant loss Etiology of peri-implant diseases Risk factors for peri-implant diseases Peri-implant mucositis Peri-implantitis: risk factors related to the patient Peri-implantitis: risk factors related to the implant Concluding remarks References Part 3: Microbiology Chapter 8 Dental Biofilms and Calculus Introduction The human microbiome The oral microbiome The mouth as a microbial habitat Methods to determine the composition and function of the oral microbiome The development and composition of the oral microbiome Dental biofilm formation Conditioning film formation Reversible and more permanent attachment Co-adhesion Plaque maturation Detachment The significance of a biofilm and community lifestyle for microorganisms Benefits to the host of a resident oral microbiota. Biofilms on implant surfaces Dental calculus Clinical appearance and distribution Calculus formation and structure Attachment to tooth surfaces and implants Calculus composition Clinical implications Conclusions References Chapter 9 Periodontal and Peri-Implant Infections Periodontal infections Introduction Microbiological techniques to study the periodontal microbiota Periodontal bacteria and virulence Microbial pathogenesis of periodontal disease Peri-implant infections Introduction Peri-implant biofilm formation Surface characteristics of the implant/abutment Local oral environment Oral hygiene and accessibility Microbiota associated with peri-implant mucosal health Microbiota associated with peri-implant infections Periodontal and peri-implant microbiomes in health and disease Patients at risk for peri-implant infections Acknowledgment References Part 4: Host–Parasite Interactions Chapter 10 Pathogenesis of Gingivitis and Periodontitis Introduction Gingivitis Development of the homeostatic lesion The epithelial barrier Factors influencing the pathogenesis of gingivitis Vascular response Cellular response Repair potential Periodontitis Histopathology of periodontitis B cells in periodontitis Macrophages in periodontitis (M1 and M2) Conversion of gingivitis to periodontitis The Th1/Th2 paradigm Suppression of cell-mediated immunity T cells and homeostasis Cytokine profiles CD8 T cells Control of the Th1/Th2 balance Genetics Innate immune response Nature of the antigen Nature of the antigen-presenting cell Hypothalamic–pituitary–adrenal axis and the sympathetic nervous system Treg/Th17 axis Autoimmunity Natural killer T cells B-cell subsets Connective tissue matrix destruction Bone loss Conclusion References Chapter 11 Systemic and Environmental Modifying Factors Introduction Diabetes mellitus Mechanisms underlying the effect of diabetes on periodontitis Clinical presentation of the periodontal patient with diabetes Concepts related to patient management Tobacco smoking Mechanisms underlying the effect of smoking on periodontitis Clinical presentation of the periodontal patient who smokes Concepts related to patient management Obesity and nutrition Osteoporosis Stress References Chapter 12 Genetic Susceptibility to Periodontal Disease: New Insights and Challenges Introduction Evidence for the role of genetics in periodontitis Heritability Heritability of periodontitis among young people Heritability of periodontitis in adults Gene mutation of major effect on human disease and its association with periodontitis Identification of genetic risk factors of periodontitis Sialic acid binding IG like lectin 5 (SIGLEC5) and other potential variants Defensin alpha-1 and -3 (DEFA1A3) CDKN2B antisense RNA 1 (CDKN2B-AS1) Miscellaneous genetic associations with periodontitis Epigenetic signatures From genetic disease susceptibility to improved oral care References Part 5: Trauma from Occlusion Chapter 13 Effect of Load on Periodontal and Peri-Implant Tissues Introduction Part I: Periodontal tissues Definition and terminology Occlusal trauma and plaque-associated periodontal disease Conclusion Part II: Peri-implant tissues Orthodontic loading and alveolar bone Bone reactions to functional loading Excessive occlusal load on implants Static and cyclic loads on implants Load and loss of osseointegration Masticatory occlusal forces on implants Tooth–implant supported reconstructions References Part 6 Periodontal Pathology Chapter 14 Non-Plaque-Induced Gingival Diseases Introduction Genetic/developmental disorders Hereditary gingival fibromatosis Specific infections Bacterial origin Viral origin Fungal origin Inflammatory and immune conditions Hypersensitivity reactions Autoimmune diseases of skin and mucous membranes Granulomatous inflammatory lesions (orofacial granulomatosis) Reactive processes Epulis Neoplasms Premalignant (potentially malignant) Malignancy Endocrine, nutritional, and metabolic diseases Vitamin deficiencies Traumatic lesions Physical/mechanical trauma Chemical (toxic) burn Thermal insults Gingival pigmentation Chapter 15 Plaque-Induced Gingivitis Clinical features of plaque]induced gingivitis Diagnostic criteria to assess a gingivitis lesion Diagnostic criteria to define and grade a gingivitis case Epidemiology of gingivitis Impact of gingivitis on patient]reported quality of life Impact of gingivitis on systemic inflammation Prognostic value of gingivitis Potential modifying factors of plaque]induced gingivitis Smoking Sex steroid hormones Malnutrition Specific systemic diseases and conditions Systemic drugs Local factors Prevention and management of plaque-induced gingivitis Chapter 16 Current Classification of Periodontitis Introduction A brief historical perspective: recently used periodontitis classification systems Need for the new classification Key concepts and ground rules of the new classification of periodontitis Assessment of Stage Assessment of grade Implementation of the current classification: clinical examples Interpretational challenges and “gray zones” The value of the 2018 periodontitis classification Acknowledgment Chapter 17 Effect of Periodontal Diseases on General Health: Periodontal Medicine Introduction Evidence of common biologic mechanisms Oral microbiome Systemic inflammation Atherosclerotic vascular disease Biologic mechanisms Epidemiologic evidence Diabetes mellitus Biological mechanisms Epidemiologic evidence Adverse pregnancy outcomes Biological mechanisms Epidemiologic evidence Chronic renal disease Biological mechanisms Epidemiologic evidence Cognitive decline/dementia Biological mechanisms Epidemiologic evidence Cancer Biological mechanisms Epidemiologic evidence Conclusion Chapter 18 Periodontitis and Systemic Diseases (Cardiovascular Disease and Diabetes): Biological Perspectives for Oral/Periodontal Implications Introduction Plausibility of periodontal disease as a risk factor for diseases at distant tissues Plausibility of systemic dissemination of oral bacteria Inflammatory processes as a link between periodontal and systemic diseases Biological plausibility of a link between periodontal diseases and cardiovascular diseases Microbial factors Host factors Summary Biological plausibility of a link between periodontal diseases and diabetes Host factors Microbial factors Summary Conclusion Chapter 19 Abscesses, Necrotizing Lesions of the Periodontium, and Endo-Periodontal Lesions Introduction Abscesses in the periodontium Periodontal abscess Classification Etiology, pathogenesis, and histopathology Microbiology Diagnosis Differential diagnosis Why periodontal abscesses are relevant Necrotizing periodontal diseases What are necrotizing periodontal diseases Classification Etiology, pathogenesis, and histopathology Predisposing factors Diagnosis Necrotizing gingivitis Necrotizing periodontitis Necrotizing stomatitis Why necrotizing periodontal diseases are relevant Endo]periodontal lesions Classification Etiology Microbiology Pathogenesis and histopathology Risk factors Clinical presentation and diagnosis Summary Part 7: Peri-Implant Pathology Chapter 20 Peri-Implant Mucositis and Peri-Implantitis Introduction Healthy peri-implant mucosa Peri-implant mucositis Clinical features and diagnosis Clinical models Preclinical models Peri-implantitis Clinical features and diagnosis Human biopsy material Preclinical models Conclusion References Part 8: Tissue Regeneration Chapter 21 Periodontal Wound Healing and Regeneration Introduction Wound healing: Outcomes and definitions Wound healing biology Phases of wound healing Factors that affect healing Periodontal wound healing Healing after periodontal surgery Advanced regenerative approaches to periodontal tissue reconstruction Regenerative surgery Guided tissue regeneration Clinical applications of growth factors for use in periodontal regeneration Cell therapy for periodontal regeneration Gene therapeutics for periodontal tissue repair Three-dimensional printed scaffolds for periodontal regeneration Conclusion Acknowledgments References Volume-II Title Page Copyright Page Contents Contributors Preface Part 9: Examination Protocols Chapter 22 Examination of Patients Patient’s history Chief complaint and expectations Social and family history Dental history Oral hygiene habits History of tobacco use Medical history and medications Genetic testing before periodontal and implant therapy Signs and symptoms of periodontal diseases and their assessment Gingiva Keratinized mucosa at implant recipient sites Periodontal ligament and the root cementum Alveolar bone Diagnosis and classification of periodontitis Gingivitis Periodontitis Oral hygiene status Additional dental examinations Conclusion Chapter 23 Diagnostic Imaging of the Periodontal and Implant Patient Introduction Basic principles of diagnostic imaging in dental medicine Modalities Radiation hazards and radiation dose protection Diagnostic imaging in periodontology General recommendations Future trends and developments Diagnostic imaging in oral implantology General recommendations for implant treatment planning purposes Recommendations during and after implant placement (follow-up) Recommendations for special indications and techniques Future trends and developments Conclusions and future outlook Chapter 24 Patient-Specific Risk Assessment for Implant Therapy Introduction Systemic factors Medical conditions Medications Age Growth considerations Untreated periodontitis and oral hygiene habits History of treated periodontitis Compliance with supportive therapy Tobacco use history Genetic susceptibility traits Conclusion Part 10: Treatment PlanningProtocols Chapter 25 Treatment Planning of Patients with Periodontal Diseases Introduction Treatment goals Systemic phase (including smoking counseling) Initial phase (hygienic phase, infection control) Corrective phase (additional therapeutic measures) Screening for periodontal disease Basic periodontal examination Diagnosis Treatment planning Initial treatment plan Pretherapeutic single tooth prognosis (Fig. 255) Case presentations Case presentation 1 Case presentation 2 Conclusion References Chapter 26 Systemic Phase of Therapy Introduction Protection of the dental team and their patients against infectious diseases Protection of the patient’s health Prevention of complications Infective endocarditis and its prevention Bleeding Cardiovascular incidents Allergic reactions and drug interactions Systemic diseases, disorders, or conditions influencing pathogenesis and healing potential Specific medications: bisphosphonates as a threat to implant therapy Control of anxiety and pain Tobacco use cessation counseling Tobacco use brief intervention Conclusion References Part 11: Initial Periodontal Therapy (Infection Control) Chapter 27 Oral Hygiene Motivation Health behavior change counseling in periodontal care The challenge Clinician–patient communication Evidence for health behavior change counseling Evidence in general health care Evidence in periodontal care Understanding health behavior change counseling General principles Giving advice Agenda setting Readiness ruler Goal setting, planning, and self-monitoring Technology to facilitate behavior change The patient activation fabric Band I: establish rapport Band II: information exchange Band III: closing Ribbon A: communication style Ribbon B: health behavior change tools Case examples Oral hygiene motivation I Oral hygiene motivation II Conclusion References Chapter 28 Mechanical Supragingival Plaque Control Importance of supragingival plaque removal Self-performed plaque control Brushing Motivation Oral hygiene instruction Oral mHealth Toothbrushing Manual toothbrushes Electric (powered) toothbrushes Electrically active (ionic) toothbrush Interdental cleaning Dental floss and tape Woodsticks Rubber/elastomeric interdental cleaning sticks Interdental brushes Single-tufted/end-tufted brushes Dental water jets/oral irrigators Tongue cleaners Foam brushes, swabs, or tooth towelettes Dentifrices Side effects Brushing force Toothbrush abrasion Toothbrush contamination Importance of instruction and motivation in mechanical plaque control First session Second session Third and subsequent sessions Conclusion Acknowledgments References Chapter 29 Chemical Dental Biofilm Control Rationale for supragingival biofilm control Oral hygiene products Mechanical biofilm control Limitations of mechanical biofilm control Chemical biofilm control Mechanism of action Categories of formulations Ideal features Evaluation of activity of agents for chemical biofilm control In vitro studies In vivo study models Home-use clinical trials Active agents Antibiotics Enzymes: disruption of the biofilm Enzymes: enhancement of the host defences Amine alcohols Detergents Oxygenating agents Metal salts: zinc salts Metal salts: stannous fluoride Metal salts: stannous fluoride with amine fluoride Other fluorides Natural products Essential oils Triclosan Bisbiguanides Quaternary ammonium compounds Hexetidine Povidone iodine Other evaluated products Future approaches Delivery formats Mouth rinses Dentifrices Gels Chewing gums Varnishes Lozenges Irrigators Sprays Sustained-release devices Selection of delivery format Clinical indications for chemical plaque control: selection of agents Single use Short-term use for the prevention of dental biofilm formation Short-term use for therapy Long-term use for the prevention of dental biofilm formation Long-term use for the prevention of other oral conditions Conclusion References Chapter 30 Non-Surgical Therapy Introduction Goal of non-surgical pocket/root instrumentation Debridement, scaling, and root planing Instruments used for non-surgical pocket/root debridement Hand instruments Sonic and ultrasonic instruments Air-polishing devices Ablative laser devices Approaches to subgingival debridement Full-mouth instrumentation protocols Full-mouth disinfection protocols Clinical outcomes following various approaches to pocket/root instrumentation Microbiologic outcomes following various approaches to pocket/root instrumentation Considerations in relation to selection of instruments and treatment approach Selection of instruments Selection of treatment approach Re-evaluation following initial non-surgical periodontal treatment Efficacy of repeated non-surgical pocket/root instrumentation References Chapter 31 Treatment of Acute Periodontal and Endo-Periodontal Lesions Introduction Treatment of periodontal abscesses Control of the acute condition Re-evaluation of treatment outcomes Management of the pre-existing and/or residual lesion Treatment of necrotizing periodontal diseases Treatment of necrotizing periodontal diseases in moderately and/or short-term immunocompromised patients Treatment of necrotizing periodontal diseases in continuously and severely immunocompromised patients Treatment of endo-periodontal lesions Prognosis of teeth with endo-periodontal lesions Should endo-periodontal lesions with hopeless or poor prognosis be treated? Steps in the management of an endo-periodontal lesion References Part 12: Additional Therapy Chapter 32 Periodontal Surgery Introduction Techniques in periodontal surgery (historical perspective) Gingivectomy procedures Flap procedures Apically repositioned flap Modified Widman flap Distal wedge procedures Osseous surgery Techniques in periodontal surgery (current perspective) Objectives of surgical treatment Indications for surgical treatment Contraindications for periodontal surgery Selection of the surgical technique Instruments used in periodontal surgery Step by step flap surgical procedure Specific surgical interventions for papilla management Papilla preservation flap Modified papilla preservation technique Simplified papilla preservation flap Minimally invasive surgical techniques Outcomes of surgical periodontal therapy Histological healing Clinical outcomes of surgical periodontal therapy Factors affecting clinical healing Conclusion References Chapter 33 Treatment of Furcation-Involved Teeth Anatomy Diagnosis of furcation involvement Clinical diagnosis of furcation involvement Classification of furcation involvement Distinction between class II and class III furcation involvement The vertical dimension of furcation involvement Radiographic diagnosis of furcation involvement Furcations and risk of tooth loss Treatment options Non-surgical treatment Corrective surgery in furcation defects Decision making (clinical recommendations) in the surgical treatment of class II and III furcation defects (Sanz et al. 2020) Long-term maintenance of teeth with furcation involvement Tooth loss by vertical furcation component References Chapter 34 Non-Surgical Therapy of Peri-Implant Mucositis and Peri-Implantitis Introduction Non-surgical therapy of peri-implant mucositis Assessment of the implant-supported prosthesis Oral hygiene measures for self-performed biofilm removal Professional mechanical debridement (supra- and submucosal calculus and biofilm removal) Adjunctive measures for peri-implant mucositis treatment Non-surgical therapy ofperi-implantitis Professional mechanical debridement References Chapter 35 Surgical Treatment of Peri-Implantitis Introduction and goals of surgical therapy Implant surface decontamination Pocket elimination/reduction procedures Preclinical data Clinical data Reconstructive procedures Preclinical data Clinical data Conclusion References Chapter 36 Systemic Antibiotics in Periodontal Therapy Introduction Microbiological basis for periodontal treatment The long search for periodontal pathogens and the concept of beneficial species Understanding the target: bacterial biofilms Rationale for the use of adjunctive systemic antibiotics in periodontal treatment Mechanical periodontal therapy and its limitations Local versus systemic antimicrobials Systemic antibiotics in periodontal therapy Should systemic antimicrobial therapy be aimed at specific pathogens? Which antimicrobial(s) would provide the most predictable results? A historical perspective Which antimicrobial(s) would provide the most predictable results? Weighting the evidence: clinical outcomes in randomized clinical trials and systematic reviews Which antimicrobial(s) would provide the most predictable results? Microbiological impact Which subjects would benefit most from systemic antimicrobial therapy? Protocols of use of systemic antimicrobials in periodontics Use of systemic antimicrobials: associated risks Adverse events/reactions Emergence of resistant strains/global increase in antibiotic resistance Concluding remarks and recommendations for clinical practice References Chapter 37 Local Antimicrobial Delivery for the Treatment of Periodontitis and Peri-Implant Diseases General principles of local drug delivery Rationale of local drug delivery Subgingival pharmacokinetics Development of subgingival delivery devices Antimicrobial effects of subgingival delivery devices Local antimicrobial delivery for the treatment of periodontitis Efficacy of subgingival delivery devices Indications for locally delivered, sustained-release antimicrobials Summary Local antimicrobial delivery for the treatment of peri-implant diseases Clinical rationale Efficacy of subgingival delivery devices in peri-implant diseases Indications for locally delivered, sustained-release antimicrobials in peri-implantitis Summary References Part 13: Reconstructive Therapy Chapter 38 Regenerative Periodontal Therapy Introduction Classification and diagnosis of periodontal osseous defects Clinical indications Long-term effects and benefits of regeneration Evidence for clinical efficacy and effectiveness Patient, defect, and tooth prognostic factors Patient factors Defect factors Tooth factors Factors affecting the clinical outcomes in furcations Relevance of the surgical approach Surgical approach to intrabony defects Papilla preservation flaps Postoperative regimen Postoperative period and local side effects Surgical and postsurgical morbidity Barrier materials for regenerative surgery Non-bioresorbable materials Bioresorbable materials Membranes for intrabony defects Membranes for furcation involvement Bone replacement grafts Grafts for intrabony defects Grafts for furcation involvement Biologically active regenerative materials Growth factors for intrabony defects Growth factors for furcation involvement Enamel matrix derivatives for intrabony defects Enamel matrix derivatives for furcation involvement Combination therapy Combination therapy for intrabony defects Combination therapy for furcation involvement Root surface biomodification Clinical potential and limits for regeneration Clinical strategies Clinical flowcharts Conclusion References Chapter 39 Mucogingival Therapy: Periodontal Plastic Surgery Introduction Mucogingival conditions Mucogingival condition without gingival recession Gingival dimensions and periodontal health Gingival augmentation Mucogingival condition with gingival recessions Diagnosis of gingival recessions Treatment of gingival recessions Root coverage procedures Pedicle grafts Pedicle soft tissue graft procedures combined with a barrier membrane Healing of pedicle soft tissue grafts over denuded root surfaces Use of free soft tissue graft procedures Tunnel approaches for the treatment of gingival recessions The use of soft tissue substitutes for the treatment of gingival recessions Healing of free soft tissue grafts Selection of surgical procedure for root coverage Clinical outcomes of root coverage procedures Factors influencing the degree of root coverage Interdental papilla reconstruction Surgical techniques Crown-lengthening procedures Excessive gingival display Exposure of sound tooth structure Selection of the crown lengthening procedure Gingivectomy Apically positioned flaps Forced tooth eruption tooth eruption References Part 14: Surgery for Implant Installation Chapter 40 Timing of Implant Placement Introduction Type 1 placement as part of the same surgical procedure as and immediately following tooth extraction Ridge alterations in conjunction with implant placement Stability of implant Type 2 placement: completed soft tissue coverage of the tooth socket Type 3 placement: substantial bone fill has occurred in the extraction socket Type 4 placement: alveolar process is healed following tooth loss Clinical concepts Aim of therapy Success of treatment and long-term outcomes Conclusion References Part 15: Reconstructive Ridge Therapy Chapter 42 Maxillary Sinus Floor Augmentation The maxillary sinus Options for the rehabilitation of the posterior edentulous maxilla Maxillary sinus floor augmentation techniques Surgical modalities Presurgical examination and care Healing dynamics Maxillary sinus floor augmentation: lateral window approach Maxillary sinus floor augmentation: transalveolar approach Summary References Part 16: Occlusal and Prosthetic Therapy Chapter 43 Tooth-Supported Fixed Dental Prostheses Clinical symptoms of trauma from occlusion Angular bony defects Increased tooth mobility Progressive (increasing) tooth mobility Clinical assessment of tooth mobility (physiologic and pathologic tooth mobility) Treatment of increased tooth mobility Situation 1 Situation 2 Situation 3 Situation 4 Situation 5 References Chapter 44 Implant-Supported Fixed Dental Prostheses Introduction Indications for implants in the posterior dentition Therapeutic concepts at sites with sufficient bone quantity Therapeutic concepts at sites with insufficient bone quantity Diagnostics Preoperative diagnostics in the posterior dentition General considerations and decision-making for implants in the posterior dentition Decision-making between implant-supported reconstruction and tooth-supported fixed dental prostheses Provisional reconstructions Loading concepts Splinted versus single-unit restorations of multiple adjacent posterior implants Type of reconstruction(s) Applied clinical concepts Therapeutic concepts at sites with sufficient bone quantity Therapeutic concepts at sites with insufficient bone quantity Acknowledgment References Chapter 45 Implants in the Zone of Esthetic Priority Introduction Patient safety first: how to protect patients from avoidable harm? Understanding benefits and harms of implant treatments The gap between scientific evidence and what happens Transparent risk communication and shared decision-making programs Preoperative diagnostics Clinical measurements Image-guided diagnostics Visualization of prospective results for diagnostics and patient information Preoperative risk assessment Evaluation of alternative treatments and checklists Surgeon-related risk factors Provisional restorations and timing of the treatment sequences From tooth extraction to implant placement At implant placement with immediate provisionalization From implant placement to abutment connection From abutment connection to final crown/bridge placement New manufacturing techniques (CAD-CAM and 3D printing) Surgical considerations when dealing with implants in the zone of esthetic priority Surgical aspects for undisturbed wound healing Incisions and flap design Clinical concepts for replacement of a single missing tooth Sites with no or minor tissue deficiencies Sites with extended tissue deficiencies Clinical concepts for replacement of multiple missing teeth Sites with minor tissue deficiencies Sites with severe tissue deficiencies Prosthetic reconstruction in the zone of esthetic priority Decision-making process: standardized versus customized abutments Decision-making process: all-ceramic versus porcelain-fused-to-metal reconstructions Adverse esthetic outcomes Origin, causes, and prevalence of adverse esthetic outcomes Clinical findings and classification of esthetic adverse outcomes Strategies for retreatment of esthetic adverse outcomes and clinical results Concluding remarks and perspectives Acknowledgments References Chapter 46 Technical Complications in Implant Dentistry Introduction Implant fractures Implant complications Abutment and abutment screw complications Residual cement as a technical problem Prosthesis attrition and fracture Prevention of technical complications Conclusion References Part 17: Orthodontics and Periodontics Chapter 47 Tooth Movement in the Periodontally Compromised Patient Introduction: biologic principles of orthodontic tooth movement Periodontal and orthodontic diagnosis Treatment planning Periodontal considerations Orthodontic considerations Orthodontic treatment Specific orthodontic tooth movements Extrusion movements Molar up-righting Orthodontic tooth movements through cortical bone Intrusive tooth movements Orthodontic tooth movements and periodontal regeneration Pathologic tooth migration Multidisciplinary treatment of esthetic problems References Part 18: Supportive Care Chapter 48 Supportive Periodontal Therapy Introduction Definition Basic paradigms for the prevention of periodontal disease Patients at risk for periodontitis without regular supportive periodontal therapy Supportive periodontal therapy for patients with gingivitis Supportive periodontal therapy for patients with periodontitis Continuous multilevel risk assessment Subject periodontal risk assessment Conducting the patient’s individual periodontal risk assessment Tooth risk assessment Site risk assessment Objectives for supportive periodontal therapy Determination of personalized supportive periodontal therapy intervals Supportive periodontal therapy in daily practice Examination, re-evaluation, and diagnosis Motivation, re-instruction, and instrumentation Treatment of re-infected sites Polishing, fluorides, and determination of supportive periodontal therapy interval References Index EULA