Diseases and Conditions in Dentistry
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Diseases and Conditions in Dentistry
An Evidence-Based Reference
Moharamzadeh, Keyvan
John Wiley and Sons Ltd
05/2018
392
Dura
Inglês
9781119312031
15 a 20 dias
Descrição não disponível.
Contents Preface xxi Acknowledgements xxiii Image Contributors xxv Abbreviations xxvii About the Companion Webstite xxix 1 Aggressive Periodontitis 1 1.1 Definition 1 1.1.1 Primary Features 1 1.1.2 Secondary Features 1 1.2 Classification 1 1.3 Prevalence 1 1.4 Aetiology and Pathogenesis 1 1.4.1 Bacteria 2 1.4.2 Genetic Susceptibility 2 1.4.3 Smoking 2 1.5 Screening 2 1.6 Diagnosis 2 1.7 Prognosis 2 1.8 Treatment 2 1.8.1 Systemic Antibiotics 3 1.8.2 Local Antimicrobials 3 References 8 2 Amelogenesis Imperfecta 11 2.1 Definition 11 2.2 Aetiology 11 2.3 Epidemiology 11 2.4 Classification 11 2.5 Diagnostic Clinical Features 11 2.5.1 Hypoplastic Type 11 2.5.2 Hypocalcified Type 11 2.5.3 Hypomaturation Type 11 2.6 Relevant History 12 2.7 Relevant Investigations 12 2.8 Prognosis 12 2.9 Treatment Considerations 12 2.9.1 Management of Children 12 2.9.2 Mixed Dentition 13 2.9.3 Permanent Dentition 13 2.9.4 Adulthood 13 2.10 Survival of Restorations 13 References 18 3 Apical Periodontitis 19 3.1 Definitions and Classification 19 3.2 Relevant Anatomy 19 3.3 Immunopathology 19 3.4 Aetiology 20 3.5 Microbiology 20 3.6 Radiology 21 3.7 Diagnosis 21 3.8 Epidemiology 23 3.9 Endodontic Treatment Considerations 23 3.9.1 Local Anaesthesia 23 3.9.2 Isolation and Disinfection 23 3.9.3 Access Cavity Preparation 23 3.9.4 Magnification 23 3.9.5 Working Length Determination 23 3.9.6 Root Canal Preparation Techniques 24 3.9.7 Irrigation and Debridement 24 3.9.8 Interappointment Medication 24 3.9.9 Obturation Techniques 24 3.9.10 Coronal Restoration 25 3.9.11 Review 25 3.9.12 Exacerbation 25 3.10 Endodontic Retreatment 25 3.11 Prognosis and Outcome of Non-Surgical Endodontic Treatment 26 3.11.1 Preoperative Factors 26 3.11.2 Intraoperative Factors 26 3.11.3 Post-Treatment Factors 26 3.12 Surgical Endodontic Treatment 26 3.12.1 Indications 26 3.12.2 Contraindications 26 3.12.3 Flap Design 27 3.12.4 Specific Anatomy 27 3.12.5 Bone Removal 27 3.12.6 Root End Preparation 27 3.12.7 Root End Filling 27 3.12.8 Prognosis and Outcomes 27 3.12.8.1 Preoperative Factors 28 3.12.8.2 Intraoperative Factors 28 References 29 4 Bisphosphonates and Medication-Related Osteonecrosis of the Jaw 33 4.1 Definition and Staging 33 4.2 Pathogenesis 33 4.3 Prevalence 33 4.4 Prevention 34 4.5 Assessment and Investigations 34 4.6 Treatment Considerations 34 References 36 5 Caries 37 5.1 Definition and Aetiology 37 5.2 Pathogenesis 37 5.3 Epidemiology 37 5.4 Classification 37 5.5 Relevant History 38 5.6 Clinical Examination of Caries 38 5.7 Differential Diagnosis 38 5.8 Prevention 38 5.8.1 Tooth Brushing and Mechanical Plaque Control 38 5.8.2 Diet 38 5.8.3 Fluoride 38 5.8.4 Fissure Sealing 39 5.9 Treatment Considerations 39 5.9.1 Primary Teeth 39 5.9.2 Permanent Teeth 39 5.9.2.1 Minimally Invasive Techniques 39 5.9.2.2 Treatment of Exposed Pulp in Permanent Teeth 40 References 41 6 Chronic Periodontitis 45 6.1 Definition and Classification 45 6.2 Clinical Features and Characteristics 45 6.3 Periodontal Indices 45 6.4 Epidemiology 47 6.5 Risk Factors 47 6.5.1 Local Risk Factors 47 6.5.2 Systemic Risk Factors 47 6.5.2.1 Smoking Tobacco 47 6.5.2.2 Diabetes 47 6.5.2.3 Genetics 48 6.5.2.4 Osteoporosis 48 6.5.2.5 Psychosocial Factors 48 6.5.2.6 Other Considerations 48 6.6 Microbiology 48 6.7 Pathogenesis 49 6.8 Role of Occlusal Trauma 49 6.9 Treatment 50 6.9.1 Treatment Goals 50 6.9.2 Treatment Phases 50 6.9.2.1 Systemic Phase 50 6.9.2.2 Initial Hygiene Phase 50 6.9.2.2.1 Mechanical Supragingival Plaque Control 50 6.9.2.2.2 Chemical Supragingival Plaque Control 51 6.9.2.3 Non-Surgical Therapy 51 6.9.2.3.1 Management of Tooth Mobility 52 6.9.2.4 Corrective Phase (Additional Therapy) 52 6.9.2.4.1 Periodontal Surgery 52 6.9.2.4.2 Outcome of Periodontal Surgery 53 6.9.2.4.3 Treatment of Teeth with Furcation Involvement 53 6.9.2.4.4 Periodontal Regeneration 54 6.9.2.5 Maintenance Phase 55 References 58 7 Cleft Lip and Palate 63 7.1 Introduction 63 7.2 Complications 63 7.3 Dental Abnormalities 63 7.4 Management of Patients with CLP 63 7.4.1 Infancy and Primary Dentition Stage 64 7.4.2 Mixed Dentition 64 7.4.3 Permanent Dentition 64 7.4.3.1 Orthodontic Treatment 64 7.4.3.2 Orthognathic Surgery 64 7.4.3.3 Distraction Osteogenesis (DO) 64 7.4.3.4 Restorative Treatment 65 References 67 8 Combination Syndrome 69 8.1 Defining Features 69 8.2 Pathogenesis 69 8.3 Clinical Assessment 69 8.4 Prevention 70 8.5 Treatment Considerations 70 8.6 Management of Flabby Ridge 70 8.7 Management of Denture-Induced Stomatitis 71 References 72 9 Complete Edentulism 75 9.1 Introduction 75 9.2 Treatment Stages 75 9.3 Denture Support 75 9.4 Challenging Conditions 75 9.5 Complete Denture Occlusion 76 9.5.1 Measuring Occlusal Vertical Dimension (OVD) 76 9.5.2 Registration of Centric Relation (CR) 76 9.5.3 Complete Denture Occlusal Schemes 76 9.5.3.1 Bilateral Balanced Occlusion 76 9.5.3.2 Monoplane Scheme of Occlusion 77 9.5.3.3 Linear Occlusion Scheme 77 9.5.4 Occlusal Adjustment 77 9.6 Setting Up the Teeth in Complete Denture 77 9.7 Tooth Size and Shape 78 9.8 Soft Liners and Tissue Conditioners 78 9.9 Copy Denture 78 9.10 Complete Denture Troubleshooting 79 References 81 10 Deep Overbite 83 10.1 Definition and Prevalence 83 10.2 Aetiology 83 10.3 Classification 83 10.4 Treatment Options 83 10.4.1 Orthodontic Treatment 83 10.4.2 Orthognathic Surgery 84 10.4.3 Prosthodontic and Restorative Treatment 84 References 86 11 Dens Invaginatus 87 11.1 Definition and Terminology 87 11.2 Aetiology and Prevalence 87 11.3 Classification 87 11.4 Clinical Examination and Investigations 87 11.5 Treatment Considerations 88 References 90 12 Dentine Hypersensitivity 93 12.1 Definition 93 12.2 Prevalence 93 12.3 Aetiology and Pathogenesis 93 12.4 History and Examination 93 12.5 Management 94 12.5.1 Management of DHS in Patients with Gingival Recession and/or Periodontal Disease 94 12.5.2 Management of DHS in Patients with Tooth Surface Loss 94 References 96 13 Dentinogenesis Imperfecta and Dentine Dysplasia 99 13.1 Definition 99 13.2 Classification and Clinical Features 99 13.3 Aetiology and Pathogenesis 99 13.4 Epidemiology 100 13.5 Differential Diagnoses 100 13.6 Relevant History and Special Investigations 100 13.7 Treatment Considerations 100 13.7.1 Primary Dentition 100 13.7.2 Permanent Dentition 101 References 104 14 Dentoalveolar Trauma 105 14.1 Introduction 105 14.2 Displaced and Malpositioned Teeth 105 14.3 Loss of Vitality and Discolouration 105 14.4 Ankylosis and Root Resorption 106 14.5 Lost Teeth 106 14.5.1 Exodontia Considerations 106 14.5.2 Role of Orthodontists 106 14.5.3 Autotransplantation 106 14.5.4 Prosthetic Tooth Replacement 107 References 113 15 Discolouration 115 15.1 Introduction 115 15.2 Intrinsic Discolouration 115 15.2.1 Alkaptonuria 115 15.2.2 Congenital Hyperbilirubinaemia 115 15.2.3 Congenital Erythropoietic Porphyria 115 15.2.4 Tetracycline Staining 115 15.2.5 Pulpal Disease 115 15.2.6 Root Resorption 116 15.2.7 Amelogenesis Imperfecta (AI) 116 15.2.8 Dentinogenesis Imperfecta (DI) 116 15.2.9 Fluorosis 116 15.2.10 Ageing 116 15.2.11 Other Conditions Associated with Enamel Defects 116 15.3 Extrinsic Discolouration 116 15.4 Treatment Options 116 15.5 Tooth Bleaching 117 15.5.1 Bleaching Techniques 117 15.5.1.1 Vital Bleaching (External Bleaching) 117 15.5.1.2 Non?Vital Bleaching (Internal Bleaching) 117 15.5.1.3 Inside/Outside Bleaching 117 15.5.2 Bleaching Products 117 15.5.2.1 Whitening Gels 117 15.5.2.2 Whitening Strips 117 References 118 16 Ectodermal Dysplasia 121 16.1 Definition and Prevalence 121 16.2 Classification 121 16.3 Aetiology 121 16.4 Diagnosis and Clinical Features 121 16.5 Management Considerations 122 16.6 Restorative Treatment 122 16.6.1 Direct Restorations 122 16.6.2 Indirect Restorations 122 16.6.3 Removable Dentures 122 16.6.4 Implants 122 References 124 17 External Root Resorption 127 17.1 Introduction 127 17.2 Aetiology and Pathogenesis 127 17.3 External Invasive Cervical Root Resorption 127 17.4 History and Examination 128 17.5 Differential Diagnosis 128 17.6 Treatment Considerations 128 17.6.1 Non?Surgical Management 128 17.6.2 Surgical Management 129 17.6.3 Endodontic Treatment 130 References 131 18 Failed Restoration and Compromised Tooth 133 18.1 Introduction 133 18.2 Direct Restorations 133 18.2.1 Amalgam Restorations 133 18.2.2 Composite Restorations 133 18.2.3 GIC, Resin?Modified GIC and Compomers 134 18.3 Indirect Restorations 134 18.3.1 Crowns 134 18.3.1.1 Porcelain Fused to Metal (PFM) Crowns 135 18.3.1.2 All?Ceramic Crowns 135 18.3.1.3 Full Gold Crowns (FGG) 135 18.3.2 Inlays and Onlays 135 18.3.3 Veneers 136 18.4 Restoration of Root?Treated Teeth 136 References 140 19 Fluorosis 143 19.1 Definition 143 19.2 Aetiology and Pathogenesis 143 19.3 Prevalence 143 19.4 Clinical Features and Classifications 143 19.5 Diagnosis 143 19.6 Treatment Considerations 144 References 146 20 Fractured Endodontic Instrument 147 20.1 Incidence 147 20.2 Causative Factors and Prevention 147 20.3 Impact on Outcome of Endodontic Treatment 147 20.4 Management Strategies 148 20.5 Factors Affecting Removal of Fractured Instruments 148 20.6 Fragment Removal 149 References 151 21 Fractured or Failed Post 153 21.1 Introduction 153 21.2 Reasons for Failure of Post?Retained Restorations 153 21.3 Factors to Consider 153 21.4 Risks of Post Removal 153 21.5 Post Removal Techniques 154 References 157 22 Gingival Enlargement and Gingivitis 159 22.1 Introduction 159 22.2 Aetiology and Clinical Features 159 22.3 Diagnosis 160 22.4 Management 160 References 164 23 Gingival Recession 165 23.1 Introduction 165 23.2 Aetiology and Risk Factors 165 23.3 Classification 166 23.4 Diagnosis 166 23.5 Prevention and Non?Surgical Management 166 23.5.1 Monitoring and Maintenance 166 23.5.2 Adhesive Restorations 166 23.5.3 Gingival Prosthesis 166 23.5.4 Orthodontic Space Closure 167 23.6 Surgical Treatment 167 23.6.1 Gingival Augmentation 167 23.6.2 Surgical Root Coverage 168 23.6.2.1 Pedicle Soft Tissue Grafts 168 23.6.2.2 Free Soft Tissue Grafts 169 23.6.2.3 Prognostic Factors 169 23.6.2.4 Clinical Outcome of Various Root Coverage Procedures 170 23.6.3 Surgical Reconstruction of Interdental Papillae 170 23.6.4 Periodontal Microsurgery 170 References 173 24 Halitosis 177 24.1 Terminology 177 24.2 Aetiology 177 24.3 Epidemiology 177 24.4 Classification 177 24.5 Diagnosis 177 24.6 Management Strategies 178 References 179 25 Hypodontia 181 25.1 Definition and Classification 181 25.2 Aetiology 181 25.3 Epidemiology 181 25.4 Clinical Features 181 25.5 History and Examination 182 25.6 Relevant Investigations 182 25.7 Care Pathway 182 25.8 Multidisciplinary Team 182 25.9 Restorative Considerations 183 25.10 Treatment Considerations 183 25.10.1 Preventive Care 183 25.10.2 Treatment Options for Missing Teeth 183 25.10.3 Missing Maxillary Lateral Incisors 183 25.10.3.1 Space Closure 183 25.10.3.2 Space Opening 184 25.10.4 Missing Mandibular Incisor Teeth 184 25.10.5 Maxillary Midline Diastema 184 25.10.6 Management of Retained Primary Teeth 184 25.10.7 Prosthetic Options to Replace the Missing Teeth 185 25.10.7.1 Resin-bonded Bridge (RBB) 185 25.10.7.2 Conventional Bridge 186 25.10.7.3 Removable Partial Denture (RPD) and Overdenture 186 25.10.7.4 Implant?Retained Prosthesis 186 25.10.8 General Maintenance Requirements 187 References 191 26 Internal Root Resorption 193 26.1 Definition 193 26.2 Pathogenesis 193 26.3 Predisposing Factors 193 26.4 Epidemiology 193 26.5 Classification 193 26.6 Diagnosis 193 26.6.1 Clinical Features 194 26.6.2 Radiographic Features 194 26.7 Treatment Considerations 194 References 196 27 Irrigation Accidents 197 27.1 Introduction 197 27.2 Types of Incidents and Common Causes 197 27.3 Signs and Symptoms 197 27.4 Prevention 197 27.5 Management 198 References 200 28 Low Maxillary Sinus Floor 201 28.1 Introduction 201 28.2 Sinus Floor Elevation Techniques 201 28.2.1 Lateral Approach 201 28.2.1.1 Indications and Contraindications 201 28.2.1.2 Preoperative Assessment 201 28.2.1.3 Surgical Approach 202 28.2.1.4 Bone Grafting 202 28.2.1.5 Postoperative Care and Complications 203 28.2.2 Crestal Approach 203 28.3 Implant Survival 203 References 204 29 Microdontia 207 29.1 Definition, Prevalence and Classification 207 29.2 Aetiology 207 29.3 Examination and Diagnosis 207 29.4 Management 207 References 210 30 Necrotising Periodontal Diseases 211 30.1 Introduction 211 30.2 Epidemiology 211 30.3 Predisposing Factors 211 30.4 Clinical Features and Diagnosis 211 30.5 Microbiology and Histology 211 30.6 Management 212 30.6.1 Acute Phase Treatment 212 30.6.2 Treatment of Chronic Periodontal Disease 212 30.6.3 Corrective Phase Treatment 212 30.4 Maintenance 212 References 213 31 Occlusal Issues and Occlusion 215 31.1 Definitions 215 31.2 Occlusal Philosophies 215 31.3 Assessment and Recording of Occlusion 216 31.4 Articulators 216 31.5 Face?bow 216 31.6 Conformative Approach 217 31.7 Reorganisation of Occlusion 217 31.8 Determinants of Posterior Occlusal Morphology 217 References 219 32 Oncology?Related Defects in Mandible 221 32.1 Introduction 221 32.2 Roles of the Multidisciplinary Team in Head and Neck Cancer Management 221 32.3 Consequences of Cancer Surgery in Mandible 222 32.4 Classification of Mandibular Defects 222 32.5 Rehabilitation of Mandibular Defects 222 32.5.1 Surgical Reconstruction of Mandibular Defects 222 32.5.2 Prosthetic Rehabilitation of Mandibular Defects 223 32.5.2.1 Pretherapy Dental Screening 223 32.5.2.2 Prosthetic Challenges 223 32.5.2.3 Conventional Prosthetic Management 224 32.5.2.4 Implants in Oncology Patients 224 32.5.2.4.1 Indications and Limitations 224 32.5.2.4.2 Relevant History and Preoperative Examination 224 32.5.2.4.3 Planning, Timing and Design Considerations 225 32.5.2.4.4 Primary Implants 225 32.5.2.4.5 Implants in Irradiated Bone 225 32.5.2.4.6 Implants in Grafted Bone Flaps 225 References 229 33 Oncology?Related Defects in Maxillae 233 33.1 Maxillary Tumours 233 33.2 Surgical Resection 233 33.3 Classification of Maxillary Defects 233 33.4 Surgical Reconstruction 234 33.4.1 Local and Regional Flaps 234 33.4.2 Soft Tissue Free Flaps 234 33.4.3 Hard Tissue or Composite Free Flaps 234 33.5 Prosthetic Treatment 234 33.6 Alterations at Surgery to Facilitate Prosthetic Treatment 234 33.7 Prosthetic Treatment Phases 235 33.7.1 Surgical Obturator 235 33.7.2 Interim Obturator 235 33.7.3 Definitive Obturator 236 33.8 Soft Palate Defects 236 33.9 Osseointegrated Implants 236 References 238 34 Open Apex (Immature Non?Vital Teeth) 241 34.1 Definition 241 34.2 Aetiology 241 34.3 Classification 241 34.4 Management Strategies 241 34.4.1 Working Length Determination in Teeth with Open Apices 241 34.4.2 Irrigation Considerations 241 34.4.3 Calcium Hydroxide Apexification 242 34.4.4 Placement of an Apical Plug to Create an Artificial Apical Barrier 242 34.4.4.1 Mineral Trioxide Aggregate 242 34.4.4.2 Biodentine (R) 242 34.4.5 Regenerative Endodontic Treatment 242 References 244 35 Open Bite 247 35.1 Definition and Classification 247 35.2 Aetiology 247 35.3 Incidence 247 35.4 Indications for Treatment 247 35.5 Treatment Options 247 35.5.1 Prevention 247 35.5.2 Orthodontic Treatment 247 35.5.3 Orthognathic Surgery 248 35.5.4 Restorative Treatment 248 References 250 36 Osteoradionecrosis 251 36.1 Definition and Pathogenesis 251 36.2 Prevalence 251 36.3 Risk Factors 251 36.4 Classification of ORN 251 36.5 Diagnosis 252 36.6 Prevention 252 36.6.1 Pre?Radiotherapy Dental Assessment and Extractions 252 36.6.2 Patient Education 252 36.6.3 Minimising Trauma 252 36.6.4 Prophylactic Hyperbaric Oxygen Therapy and Antibiotics 252 36.7 Management 253 References 254 37 Partial Edentulism - Implant Treatment 257 37.1 Introduction 257 37.2 Preoperative Patient Assessment 257 37.2.1 History 257 37.2.2 Clinical Examination 257 37.2.3 Special Investigations 257 37.3 Risk Factors 258 37.3.1 Local Risk Factors 258 37.3.2 Systemic Risk Factors 258 37.3.3 Behavioural Risk Factors 259 37.4 Risk Assessment and Patient Consent 259 37.5 Treatment Considerations 259 37.5.1 Planning Stage 259 37.5.2 Surgical Stage 260 37.5.3 Prosthetic Treatment 260 37.5.4 Replacement of the Anterior Teeth with Implants 261 37.5.5 Replacement of the Posterior Teeth with Implants 261 37.5.6 Considerations in Bruxist Patients 261 37.5.7 Maintenance 262 37.5.8 Implant Complications 262 37.5.8.1 Biological Complications 262 37.5.8.1 Mechanical Complications 262 37.5.8.1 Aesthetic Complications 263 37.5.8.1 Evidence 263 37.6 Implant Survival 263 37.6.1 Implant?Retained Single Crowns 263 37.6.2 Implant?Retained Bridge 263 37.7 Timing of Implant Placement after Tooth Extraction 263 37.8 Timing of Implant Loading 264 References 269 38 Partial Edentulism - Partial Denture Treatment 273 38.1 Introduction 273 38.2 Removable Partial Denture Types 273 38.2.1 Acrylic Dentures 273 38.2.2 Cobalt-Chromium RPDs 273 38.2.3 Flexible Dentures 274 38.2.4 Hypoallergenic Dentures 274 38.2.5 PEEK?based RPDs 274 38.3 Classification of Partially Dentate Arches 274 38.4 General Guidelines 274 38.5 RPD Design 274 38.5.1 Surveying 274 38.5.2 Occlusal Analysis 274 38.5.3 Replacing Anterior Teeth 274 38.5.4 Milled Crowns 275 38.5.5 Components of RPD Design 275 38.5.6 Saddle Areas 275 38.5.7 Rests 275 38.5.8 Retentive Clasps 275 38.5.9 Indirect Retainer 275 38.5.10 Mandibular Major Connectors 275 38.5.11 Maxillary Major Connectors 276 38.5.12 Minor Connectors 276 38.6 Swing?Lock RPD 276 References 278 39 Perforation 281 39.1 Definition 281 39.2 Causes 281 39.3 Pathogenesis 281 39.4 Epidemiology 281 39.5 Classification 281 39.6 Diagnosis 281 39.7 Prognosis 282 39.8 Management 282 39.8.1 Extraction 282 39.8.2 Non?Surgical Treatment 282 39.8.3 Surgical Treatment 282 39.9 Treatment Outcomes 283 References 285 40 Peri?Implant Diseases 287 40.1 Definitions 287 40.2 Aetiology 287 40.3 Risk Factors 287 40.4 Prevalence 287 40.5 Diagnostic Criteria 287 40.6 Patient Assessment 288 40.6.1 Implant Identification 288 40.6.2 Relevant History 288 40.6.3 Assessment of Suprastructure 288 40.6.4 Assessment of Individual Fixtures 288 40.6.5 Assessment of Peri?Implant Soft Tissue 288 40.6.6 Radiographic Assessment 288 40.7 Management of Peri?Implant Mucositis 288 40.8 Management of Peri?Implantitis 288 References 291 41 Periodontal Abscess 293 41.1 Definition and Classification 293 41.2 Pathogenesis 293 41.3 Prevalence 293 41.4 Microbiology 293 41.5 Diagnosis 293 41.6 Differential Diagnosis 294 41.7 Treatment 294 References 296 42 Periodontic?Endodontic Lesion 297 42.1 Definition and Classification 297 42.2 Diagnosis 297 42.3 Prognosis 297 42.4 Management 298 References 300 43 Periodontitis as a Manifestation of Systemic Disease 301 43.1 Introduction 301 43.2 Periodontitis Associated with Haematological Disorders 301 43.3 Periodontitis Associated with Genetic Disorders 301 43.4 Periodontitis Associated with Other Conditions (Not Otherwise Specified Group) 303 References 305 44 Radiotherapy Side Effects 307 44.1 Introduction 307 44.2 Radiation?Induced Oral Mucositis 307 44.3 Xerostomia 308 44.3.1 Organ?Sparing Radiotherapy 308 44.3.2 Salivary Gland Tissue Transfer 308 44.3.3 Preventive Medication 308 44.3.4 Salivary Stimulation 308 44.3.5 Saliva Substitution 308 44.4 Oral Infections 308 44.5 Trismus (Restricted Mouth Opening) 309 References 311 45 Ridge Defects (Generalised) 313 45.1 Introduction 313 45.2 Classifications 313 45.3 Neutral Zone Impression Technique for Resorbed Ridges 313 45.4 Magnet?Retained Conventional Overdenture 314 45.5 Implant?Supported Overdentures 314 45.6 Full?Arch Implant?Retained Fixed Prosthesis 315 References 317 46 Ridge Defects (Localised) 319 46.1 Introduction 319 46.2 Ridge Augmentation by Soft Tissue Grafts 319 46.3 Ridge Augmentation with Hard Tissue Surgery 320 46.3.1 Anatomical Repositioning Techniques 320 46.3.2 Bone Grafting 320 References 324 47 Shortened Dental Arch (SDA) 325 47.1 Definition 325 47.2 History 325 47.3 Effect of SDA on Oral Health?Related Quality of Life 325 47.4 Effect of Tooth Loss on Masticatory Function 325 47.5 Effect of SDA on Occlusal Stability 325 47.6 Effect of SDA on Temporomandibular Joint 326 47.7 Alternative Treatment Options 326 References 327 48 Supernumerary, Fusion and Gemination 329 48.1 Supernumerary (Hyperdontia) 329 48.1.1 Prevalence 329 48.1.2 Classification 329 48.1.3 Aetiology 329 48.1.4 Oral and Dental Complications 329 48.1.5 Examination and Diagnosis 329 48.1.6 Management 330 48.2 Fusion 330 48.2.1 Classification 330 48.2.2 Aetiology 330 48.2.3 Incidence 330 48.2.4 Relevant Investigations 330 48.2.5 Treatment Options 330 48.3 Gemination 331 References 332 49 Temporomandibular Disorders 335 49.1 Definition 335 49.2 Prevalence 335 49.3 Classification 335 49.4 Aetiology 335 49.5 Diagnosis 336 49.6 Special Investigations 336 49.7 Management 336 49.7.1 Patient Education 336 49.7.2 Jaw Exercise and Manual Therapy 336 49.7.3 Acupuncture 336 49.7.4 Pharmacotherapy 337 49.7.5 Occlusal Stabilising Splint Therapy 337 49.7.6 Anterior Repositioning Splint 337 49.7.7 Occlusal Adjustment 337 49.7.8 TMJ Lavage 337 49.7.9 Surgery 337 References 338 50 Tooth Wear 341 50.1 Definitions and Clinical Features 341 50.2 Aetiology 341 50.2.1 Parafunction and Occlusion 341 50.2.2 Intrinsic Acids 341 50.2.3 Extrinsic Acids 342 50.3 Prevalence 342 50.4 Classification 342 50.5 History and Examination 343 50.6 Prevention 343 50.7 Management of Worn Teeth 343 50.7.1 Conformative Approach 343 50.7.2 Reorganisation Approach 343 50.7.3 Occlusal Splint Therapy Prior to VD Increase 344 50.7.4 Fixed Restorations 344 50.7.4.1 Direct Fixed Restorations 344 50.7.4.2 Indirect Fixed Restorations 344 50.7.5 Crown Lengthening 345 50.7.6 Removable Treatment Options 345 50.7.7 Maintenance 346 References 350 Index 355
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Contents Preface xxi Acknowledgements xxiii Image Contributors xxv Abbreviations xxvii About the Companion Webstite xxix 1 Aggressive Periodontitis 1 1.1 Definition 1 1.1.1 Primary Features 1 1.1.2 Secondary Features 1 1.2 Classification 1 1.3 Prevalence 1 1.4 Aetiology and Pathogenesis 1 1.4.1 Bacteria 2 1.4.2 Genetic Susceptibility 2 1.4.3 Smoking 2 1.5 Screening 2 1.6 Diagnosis 2 1.7 Prognosis 2 1.8 Treatment 2 1.8.1 Systemic Antibiotics 3 1.8.2 Local Antimicrobials 3 References 8 2 Amelogenesis Imperfecta 11 2.1 Definition 11 2.2 Aetiology 11 2.3 Epidemiology 11 2.4 Classification 11 2.5 Diagnostic Clinical Features 11 2.5.1 Hypoplastic Type 11 2.5.2 Hypocalcified Type 11 2.5.3 Hypomaturation Type 11 2.6 Relevant History 12 2.7 Relevant Investigations 12 2.8 Prognosis 12 2.9 Treatment Considerations 12 2.9.1 Management of Children 12 2.9.2 Mixed Dentition 13 2.9.3 Permanent Dentition 13 2.9.4 Adulthood 13 2.10 Survival of Restorations 13 References 18 3 Apical Periodontitis 19 3.1 Definitions and Classification 19 3.2 Relevant Anatomy 19 3.3 Immunopathology 19 3.4 Aetiology 20 3.5 Microbiology 20 3.6 Radiology 21 3.7 Diagnosis 21 3.8 Epidemiology 23 3.9 Endodontic Treatment Considerations 23 3.9.1 Local Anaesthesia 23 3.9.2 Isolation and Disinfection 23 3.9.3 Access Cavity Preparation 23 3.9.4 Magnification 23 3.9.5 Working Length Determination 23 3.9.6 Root Canal Preparation Techniques 24 3.9.7 Irrigation and Debridement 24 3.9.8 Interappointment Medication 24 3.9.9 Obturation Techniques 24 3.9.10 Coronal Restoration 25 3.9.11 Review 25 3.9.12 Exacerbation 25 3.10 Endodontic Retreatment 25 3.11 Prognosis and Outcome of Non-Surgical Endodontic Treatment 26 3.11.1 Preoperative Factors 26 3.11.2 Intraoperative Factors 26 3.11.3 Post-Treatment Factors 26 3.12 Surgical Endodontic Treatment 26 3.12.1 Indications 26 3.12.2 Contraindications 26 3.12.3 Flap Design 27 3.12.4 Specific Anatomy 27 3.12.5 Bone Removal 27 3.12.6 Root End Preparation 27 3.12.7 Root End Filling 27 3.12.8 Prognosis and Outcomes 27 3.12.8.1 Preoperative Factors 28 3.12.8.2 Intraoperative Factors 28 References 29 4 Bisphosphonates and Medication-Related Osteonecrosis of the Jaw 33 4.1 Definition and Staging 33 4.2 Pathogenesis 33 4.3 Prevalence 33 4.4 Prevention 34 4.5 Assessment and Investigations 34 4.6 Treatment Considerations 34 References 36 5 Caries 37 5.1 Definition and Aetiology 37 5.2 Pathogenesis 37 5.3 Epidemiology 37 5.4 Classification 37 5.5 Relevant History 38 5.6 Clinical Examination of Caries 38 5.7 Differential Diagnosis 38 5.8 Prevention 38 5.8.1 Tooth Brushing and Mechanical Plaque Control 38 5.8.2 Diet 38 5.8.3 Fluoride 38 5.8.4 Fissure Sealing 39 5.9 Treatment Considerations 39 5.9.1 Primary Teeth 39 5.9.2 Permanent Teeth 39 5.9.2.1 Minimally Invasive Techniques 39 5.9.2.2 Treatment of Exposed Pulp in Permanent Teeth 40 References 41 6 Chronic Periodontitis 45 6.1 Definition and Classification 45 6.2 Clinical Features and Characteristics 45 6.3 Periodontal Indices 45 6.4 Epidemiology 47 6.5 Risk Factors 47 6.5.1 Local Risk Factors 47 6.5.2 Systemic Risk Factors 47 6.5.2.1 Smoking Tobacco 47 6.5.2.2 Diabetes 47 6.5.2.3 Genetics 48 6.5.2.4 Osteoporosis 48 6.5.2.5 Psychosocial Factors 48 6.5.2.6 Other Considerations 48 6.6 Microbiology 48 6.7 Pathogenesis 49 6.8 Role of Occlusal Trauma 49 6.9 Treatment 50 6.9.1 Treatment Goals 50 6.9.2 Treatment Phases 50 6.9.2.1 Systemic Phase 50 6.9.2.2 Initial Hygiene Phase 50 6.9.2.2.1 Mechanical Supragingival Plaque Control 50 6.9.2.2.2 Chemical Supragingival Plaque Control 51 6.9.2.3 Non-Surgical Therapy 51 6.9.2.3.1 Management of Tooth Mobility 52 6.9.2.4 Corrective Phase (Additional Therapy) 52 6.9.2.4.1 Periodontal Surgery 52 6.9.2.4.2 Outcome of Periodontal Surgery 53 6.9.2.4.3 Treatment of Teeth with Furcation Involvement 53 6.9.2.4.4 Periodontal Regeneration 54 6.9.2.5 Maintenance Phase 55 References 58 7 Cleft Lip and Palate 63 7.1 Introduction 63 7.2 Complications 63 7.3 Dental Abnormalities 63 7.4 Management of Patients with CLP 63 7.4.1 Infancy and Primary Dentition Stage 64 7.4.2 Mixed Dentition 64 7.4.3 Permanent Dentition 64 7.4.3.1 Orthodontic Treatment 64 7.4.3.2 Orthognathic Surgery 64 7.4.3.3 Distraction Osteogenesis (DO) 64 7.4.3.4 Restorative Treatment 65 References 67 8 Combination Syndrome 69 8.1 Defining Features 69 8.2 Pathogenesis 69 8.3 Clinical Assessment 69 8.4 Prevention 70 8.5 Treatment Considerations 70 8.6 Management of Flabby Ridge 70 8.7 Management of Denture-Induced Stomatitis 71 References 72 9 Complete Edentulism 75 9.1 Introduction 75 9.2 Treatment Stages 75 9.3 Denture Support 75 9.4 Challenging Conditions 75 9.5 Complete Denture Occlusion 76 9.5.1 Measuring Occlusal Vertical Dimension (OVD) 76 9.5.2 Registration of Centric Relation (CR) 76 9.5.3 Complete Denture Occlusal Schemes 76 9.5.3.1 Bilateral Balanced Occlusion 76 9.5.3.2 Monoplane Scheme of Occlusion 77 9.5.3.3 Linear Occlusion Scheme 77 9.5.4 Occlusal Adjustment 77 9.6 Setting Up the Teeth in Complete Denture 77 9.7 Tooth Size and Shape 78 9.8 Soft Liners and Tissue Conditioners 78 9.9 Copy Denture 78 9.10 Complete Denture Troubleshooting 79 References 81 10 Deep Overbite 83 10.1 Definition and Prevalence 83 10.2 Aetiology 83 10.3 Classification 83 10.4 Treatment Options 83 10.4.1 Orthodontic Treatment 83 10.4.2 Orthognathic Surgery 84 10.4.3 Prosthodontic and Restorative Treatment 84 References 86 11 Dens Invaginatus 87 11.1 Definition and Terminology 87 11.2 Aetiology and Prevalence 87 11.3 Classification 87 11.4 Clinical Examination and Investigations 87 11.5 Treatment Considerations 88 References 90 12 Dentine Hypersensitivity 93 12.1 Definition 93 12.2 Prevalence 93 12.3 Aetiology and Pathogenesis 93 12.4 History and Examination 93 12.5 Management 94 12.5.1 Management of DHS in Patients with Gingival Recession and/or Periodontal Disease 94 12.5.2 Management of DHS in Patients with Tooth Surface Loss 94 References 96 13 Dentinogenesis Imperfecta and Dentine Dysplasia 99 13.1 Definition 99 13.2 Classification and Clinical Features 99 13.3 Aetiology and Pathogenesis 99 13.4 Epidemiology 100 13.5 Differential Diagnoses 100 13.6 Relevant History and Special Investigations 100 13.7 Treatment Considerations 100 13.7.1 Primary Dentition 100 13.7.2 Permanent Dentition 101 References 104 14 Dentoalveolar Trauma 105 14.1 Introduction 105 14.2 Displaced and Malpositioned Teeth 105 14.3 Loss of Vitality and Discolouration 105 14.4 Ankylosis and Root Resorption 106 14.5 Lost Teeth 106 14.5.1 Exodontia Considerations 106 14.5.2 Role of Orthodontists 106 14.5.3 Autotransplantation 106 14.5.4 Prosthetic Tooth Replacement 107 References 113 15 Discolouration 115 15.1 Introduction 115 15.2 Intrinsic Discolouration 115 15.2.1 Alkaptonuria 115 15.2.2 Congenital Hyperbilirubinaemia 115 15.2.3 Congenital Erythropoietic Porphyria 115 15.2.4 Tetracycline Staining 115 15.2.5 Pulpal Disease 115 15.2.6 Root Resorption 116 15.2.7 Amelogenesis Imperfecta (AI) 116 15.2.8 Dentinogenesis Imperfecta (DI) 116 15.2.9 Fluorosis 116 15.2.10 Ageing 116 15.2.11 Other Conditions Associated with Enamel Defects 116 15.3 Extrinsic Discolouration 116 15.4 Treatment Options 116 15.5 Tooth Bleaching 117 15.5.1 Bleaching Techniques 117 15.5.1.1 Vital Bleaching (External Bleaching) 117 15.5.1.2 Non?Vital Bleaching (Internal Bleaching) 117 15.5.1.3 Inside/Outside Bleaching 117 15.5.2 Bleaching Products 117 15.5.2.1 Whitening Gels 117 15.5.2.2 Whitening Strips 117 References 118 16 Ectodermal Dysplasia 121 16.1 Definition and Prevalence 121 16.2 Classification 121 16.3 Aetiology 121 16.4 Diagnosis and Clinical Features 121 16.5 Management Considerations 122 16.6 Restorative Treatment 122 16.6.1 Direct Restorations 122 16.6.2 Indirect Restorations 122 16.6.3 Removable Dentures 122 16.6.4 Implants 122 References 124 17 External Root Resorption 127 17.1 Introduction 127 17.2 Aetiology and Pathogenesis 127 17.3 External Invasive Cervical Root Resorption 127 17.4 History and Examination 128 17.5 Differential Diagnosis 128 17.6 Treatment Considerations 128 17.6.1 Non?Surgical Management 128 17.6.2 Surgical Management 129 17.6.3 Endodontic Treatment 130 References 131 18 Failed Restoration and Compromised Tooth 133 18.1 Introduction 133 18.2 Direct Restorations 133 18.2.1 Amalgam Restorations 133 18.2.2 Composite Restorations 133 18.2.3 GIC, Resin?Modified GIC and Compomers 134 18.3 Indirect Restorations 134 18.3.1 Crowns 134 18.3.1.1 Porcelain Fused to Metal (PFM) Crowns 135 18.3.1.2 All?Ceramic Crowns 135 18.3.1.3 Full Gold Crowns (FGG) 135 18.3.2 Inlays and Onlays 135 18.3.3 Veneers 136 18.4 Restoration of Root?Treated Teeth 136 References 140 19 Fluorosis 143 19.1 Definition 143 19.2 Aetiology and Pathogenesis 143 19.3 Prevalence 143 19.4 Clinical Features and Classifications 143 19.5 Diagnosis 143 19.6 Treatment Considerations 144 References 146 20 Fractured Endodontic Instrument 147 20.1 Incidence 147 20.2 Causative Factors and Prevention 147 20.3 Impact on Outcome of Endodontic Treatment 147 20.4 Management Strategies 148 20.5 Factors Affecting Removal of Fractured Instruments 148 20.6 Fragment Removal 149 References 151 21 Fractured or Failed Post 153 21.1 Introduction 153 21.2 Reasons for Failure of Post?Retained Restorations 153 21.3 Factors to Consider 153 21.4 Risks of Post Removal 153 21.5 Post Removal Techniques 154 References 157 22 Gingival Enlargement and Gingivitis 159 22.1 Introduction 159 22.2 Aetiology and Clinical Features 159 22.3 Diagnosis 160 22.4 Management 160 References 164 23 Gingival Recession 165 23.1 Introduction 165 23.2 Aetiology and Risk Factors 165 23.3 Classification 166 23.4 Diagnosis 166 23.5 Prevention and Non?Surgical Management 166 23.5.1 Monitoring and Maintenance 166 23.5.2 Adhesive Restorations 166 23.5.3 Gingival Prosthesis 166 23.5.4 Orthodontic Space Closure 167 23.6 Surgical Treatment 167 23.6.1 Gingival Augmentation 167 23.6.2 Surgical Root Coverage 168 23.6.2.1 Pedicle Soft Tissue Grafts 168 23.6.2.2 Free Soft Tissue Grafts 169 23.6.2.3 Prognostic Factors 169 23.6.2.4 Clinical Outcome of Various Root Coverage Procedures 170 23.6.3 Surgical Reconstruction of Interdental Papillae 170 23.6.4 Periodontal Microsurgery 170 References 173 24 Halitosis 177 24.1 Terminology 177 24.2 Aetiology 177 24.3 Epidemiology 177 24.4 Classification 177 24.5 Diagnosis 177 24.6 Management Strategies 178 References 179 25 Hypodontia 181 25.1 Definition and Classification 181 25.2 Aetiology 181 25.3 Epidemiology 181 25.4 Clinical Features 181 25.5 History and Examination 182 25.6 Relevant Investigations 182 25.7 Care Pathway 182 25.8 Multidisciplinary Team 182 25.9 Restorative Considerations 183 25.10 Treatment Considerations 183 25.10.1 Preventive Care 183 25.10.2 Treatment Options for Missing Teeth 183 25.10.3 Missing Maxillary Lateral Incisors 183 25.10.3.1 Space Closure 183 25.10.3.2 Space Opening 184 25.10.4 Missing Mandibular Incisor Teeth 184 25.10.5 Maxillary Midline Diastema 184 25.10.6 Management of Retained Primary Teeth 184 25.10.7 Prosthetic Options to Replace the Missing Teeth 185 25.10.7.1 Resin-bonded Bridge (RBB) 185 25.10.7.2 Conventional Bridge 186 25.10.7.3 Removable Partial Denture (RPD) and Overdenture 186 25.10.7.4 Implant?Retained Prosthesis 186 25.10.8 General Maintenance Requirements 187 References 191 26 Internal Root Resorption 193 26.1 Definition 193 26.2 Pathogenesis 193 26.3 Predisposing Factors 193 26.4 Epidemiology 193 26.5 Classification 193 26.6 Diagnosis 193 26.6.1 Clinical Features 194 26.6.2 Radiographic Features 194 26.7 Treatment Considerations 194 References 196 27 Irrigation Accidents 197 27.1 Introduction 197 27.2 Types of Incidents and Common Causes 197 27.3 Signs and Symptoms 197 27.4 Prevention 197 27.5 Management 198 References 200 28 Low Maxillary Sinus Floor 201 28.1 Introduction 201 28.2 Sinus Floor Elevation Techniques 201 28.2.1 Lateral Approach 201 28.2.1.1 Indications and Contraindications 201 28.2.1.2 Preoperative Assessment 201 28.2.1.3 Surgical Approach 202 28.2.1.4 Bone Grafting 202 28.2.1.5 Postoperative Care and Complications 203 28.2.2 Crestal Approach 203 28.3 Implant Survival 203 References 204 29 Microdontia 207 29.1 Definition, Prevalence and Classification 207 29.2 Aetiology 207 29.3 Examination and Diagnosis 207 29.4 Management 207 References 210 30 Necrotising Periodontal Diseases 211 30.1 Introduction 211 30.2 Epidemiology 211 30.3 Predisposing Factors 211 30.4 Clinical Features and Diagnosis 211 30.5 Microbiology and Histology 211 30.6 Management 212 30.6.1 Acute Phase Treatment 212 30.6.2 Treatment of Chronic Periodontal Disease 212 30.6.3 Corrective Phase Treatment 212 30.4 Maintenance 212 References 213 31 Occlusal Issues and Occlusion 215 31.1 Definitions 215 31.2 Occlusal Philosophies 215 31.3 Assessment and Recording of Occlusion 216 31.4 Articulators 216 31.5 Face?bow 216 31.6 Conformative Approach 217 31.7 Reorganisation of Occlusion 217 31.8 Determinants of Posterior Occlusal Morphology 217 References 219 32 Oncology?Related Defects in Mandible 221 32.1 Introduction 221 32.2 Roles of the Multidisciplinary Team in Head and Neck Cancer Management 221 32.3 Consequences of Cancer Surgery in Mandible 222 32.4 Classification of Mandibular Defects 222 32.5 Rehabilitation of Mandibular Defects 222 32.5.1 Surgical Reconstruction of Mandibular Defects 222 32.5.2 Prosthetic Rehabilitation of Mandibular Defects 223 32.5.2.1 Pretherapy Dental Screening 223 32.5.2.2 Prosthetic Challenges 223 32.5.2.3 Conventional Prosthetic Management 224 32.5.2.4 Implants in Oncology Patients 224 32.5.2.4.1 Indications and Limitations 224 32.5.2.4.2 Relevant History and Preoperative Examination 224 32.5.2.4.3 Planning, Timing and Design Considerations 225 32.5.2.4.4 Primary Implants 225 32.5.2.4.5 Implants in Irradiated Bone 225 32.5.2.4.6 Implants in Grafted Bone Flaps 225 References 229 33 Oncology?Related Defects in Maxillae 233 33.1 Maxillary Tumours 233 33.2 Surgical Resection 233 33.3 Classification of Maxillary Defects 233 33.4 Surgical Reconstruction 234 33.4.1 Local and Regional Flaps 234 33.4.2 Soft Tissue Free Flaps 234 33.4.3 Hard Tissue or Composite Free Flaps 234 33.5 Prosthetic Treatment 234 33.6 Alterations at Surgery to Facilitate Prosthetic Treatment 234 33.7 Prosthetic Treatment Phases 235 33.7.1 Surgical Obturator 235 33.7.2 Interim Obturator 235 33.7.3 Definitive Obturator 236 33.8 Soft Palate Defects 236 33.9 Osseointegrated Implants 236 References 238 34 Open Apex (Immature Non?Vital Teeth) 241 34.1 Definition 241 34.2 Aetiology 241 34.3 Classification 241 34.4 Management Strategies 241 34.4.1 Working Length Determination in Teeth with Open Apices 241 34.4.2 Irrigation Considerations 241 34.4.3 Calcium Hydroxide Apexification 242 34.4.4 Placement of an Apical Plug to Create an Artificial Apical Barrier 242 34.4.4.1 Mineral Trioxide Aggregate 242 34.4.4.2 Biodentine (R) 242 34.4.5 Regenerative Endodontic Treatment 242 References 244 35 Open Bite 247 35.1 Definition and Classification 247 35.2 Aetiology 247 35.3 Incidence 247 35.4 Indications for Treatment 247 35.5 Treatment Options 247 35.5.1 Prevention 247 35.5.2 Orthodontic Treatment 247 35.5.3 Orthognathic Surgery 248 35.5.4 Restorative Treatment 248 References 250 36 Osteoradionecrosis 251 36.1 Definition and Pathogenesis 251 36.2 Prevalence 251 36.3 Risk Factors 251 36.4 Classification of ORN 251 36.5 Diagnosis 252 36.6 Prevention 252 36.6.1 Pre?Radiotherapy Dental Assessment and Extractions 252 36.6.2 Patient Education 252 36.6.3 Minimising Trauma 252 36.6.4 Prophylactic Hyperbaric Oxygen Therapy and Antibiotics 252 36.7 Management 253 References 254 37 Partial Edentulism - Implant Treatment 257 37.1 Introduction 257 37.2 Preoperative Patient Assessment 257 37.2.1 History 257 37.2.2 Clinical Examination 257 37.2.3 Special Investigations 257 37.3 Risk Factors 258 37.3.1 Local Risk Factors 258 37.3.2 Systemic Risk Factors 258 37.3.3 Behavioural Risk Factors 259 37.4 Risk Assessment and Patient Consent 259 37.5 Treatment Considerations 259 37.5.1 Planning Stage 259 37.5.2 Surgical Stage 260 37.5.3 Prosthetic Treatment 260 37.5.4 Replacement of the Anterior Teeth with Implants 261 37.5.5 Replacement of the Posterior Teeth with Implants 261 37.5.6 Considerations in Bruxist Patients 261 37.5.7 Maintenance 262 37.5.8 Implant Complications 262 37.5.8.1 Biological Complications 262 37.5.8.1 Mechanical Complications 262 37.5.8.1 Aesthetic Complications 263 37.5.8.1 Evidence 263 37.6 Implant Survival 263 37.6.1 Implant?Retained Single Crowns 263 37.6.2 Implant?Retained Bridge 263 37.7 Timing of Implant Placement after Tooth Extraction 263 37.8 Timing of Implant Loading 264 References 269 38 Partial Edentulism - Partial Denture Treatment 273 38.1 Introduction 273 38.2 Removable Partial Denture Types 273 38.2.1 Acrylic Dentures 273 38.2.2 Cobalt-Chromium RPDs 273 38.2.3 Flexible Dentures 274 38.2.4 Hypoallergenic Dentures 274 38.2.5 PEEK?based RPDs 274 38.3 Classification of Partially Dentate Arches 274 38.4 General Guidelines 274 38.5 RPD Design 274 38.5.1 Surveying 274 38.5.2 Occlusal Analysis 274 38.5.3 Replacing Anterior Teeth 274 38.5.4 Milled Crowns 275 38.5.5 Components of RPD Design 275 38.5.6 Saddle Areas 275 38.5.7 Rests 275 38.5.8 Retentive Clasps 275 38.5.9 Indirect Retainer 275 38.5.10 Mandibular Major Connectors 275 38.5.11 Maxillary Major Connectors 276 38.5.12 Minor Connectors 276 38.6 Swing?Lock RPD 276 References 278 39 Perforation 281 39.1 Definition 281 39.2 Causes 281 39.3 Pathogenesis 281 39.4 Epidemiology 281 39.5 Classification 281 39.6 Diagnosis 281 39.7 Prognosis 282 39.8 Management 282 39.8.1 Extraction 282 39.8.2 Non?Surgical Treatment 282 39.8.3 Surgical Treatment 282 39.9 Treatment Outcomes 283 References 285 40 Peri?Implant Diseases 287 40.1 Definitions 287 40.2 Aetiology 287 40.3 Risk Factors 287 40.4 Prevalence 287 40.5 Diagnostic Criteria 287 40.6 Patient Assessment 288 40.6.1 Implant Identification 288 40.6.2 Relevant History 288 40.6.3 Assessment of Suprastructure 288 40.6.4 Assessment of Individual Fixtures 288 40.6.5 Assessment of Peri?Implant Soft Tissue 288 40.6.6 Radiographic Assessment 288 40.7 Management of Peri?Implant Mucositis 288 40.8 Management of Peri?Implantitis 288 References 291 41 Periodontal Abscess 293 41.1 Definition and Classification 293 41.2 Pathogenesis 293 41.3 Prevalence 293 41.4 Microbiology 293 41.5 Diagnosis 293 41.6 Differential Diagnosis 294 41.7 Treatment 294 References 296 42 Periodontic?Endodontic Lesion 297 42.1 Definition and Classification 297 42.2 Diagnosis 297 42.3 Prognosis 297 42.4 Management 298 References 300 43 Periodontitis as a Manifestation of Systemic Disease 301 43.1 Introduction 301 43.2 Periodontitis Associated with Haematological Disorders 301 43.3 Periodontitis Associated with Genetic Disorders 301 43.4 Periodontitis Associated with Other Conditions (Not Otherwise Specified Group) 303 References 305 44 Radiotherapy Side Effects 307 44.1 Introduction 307 44.2 Radiation?Induced Oral Mucositis 307 44.3 Xerostomia 308 44.3.1 Organ?Sparing Radiotherapy 308 44.3.2 Salivary Gland Tissue Transfer 308 44.3.3 Preventive Medication 308 44.3.4 Salivary Stimulation 308 44.3.5 Saliva Substitution 308 44.4 Oral Infections 308 44.5 Trismus (Restricted Mouth Opening) 309 References 311 45 Ridge Defects (Generalised) 313 45.1 Introduction 313 45.2 Classifications 313 45.3 Neutral Zone Impression Technique for Resorbed Ridges 313 45.4 Magnet?Retained Conventional Overdenture 314 45.5 Implant?Supported Overdentures 314 45.6 Full?Arch Implant?Retained Fixed Prosthesis 315 References 317 46 Ridge Defects (Localised) 319 46.1 Introduction 319 46.2 Ridge Augmentation by Soft Tissue Grafts 319 46.3 Ridge Augmentation with Hard Tissue Surgery 320 46.3.1 Anatomical Repositioning Techniques 320 46.3.2 Bone Grafting 320 References 324 47 Shortened Dental Arch (SDA) 325 47.1 Definition 325 47.2 History 325 47.3 Effect of SDA on Oral Health?Related Quality of Life 325 47.4 Effect of Tooth Loss on Masticatory Function 325 47.5 Effect of SDA on Occlusal Stability 325 47.6 Effect of SDA on Temporomandibular Joint 326 47.7 Alternative Treatment Options 326 References 327 48 Supernumerary, Fusion and Gemination 329 48.1 Supernumerary (Hyperdontia) 329 48.1.1 Prevalence 329 48.1.2 Classification 329 48.1.3 Aetiology 329 48.1.4 Oral and Dental Complications 329 48.1.5 Examination and Diagnosis 329 48.1.6 Management 330 48.2 Fusion 330 48.2.1 Classification 330 48.2.2 Aetiology 330 48.2.3 Incidence 330 48.2.4 Relevant Investigations 330 48.2.5 Treatment Options 330 48.3 Gemination 331 References 332 49 Temporomandibular Disorders 335 49.1 Definition 335 49.2 Prevalence 335 49.3 Classification 335 49.4 Aetiology 335 49.5 Diagnosis 336 49.6 Special Investigations 336 49.7 Management 336 49.7.1 Patient Education 336 49.7.2 Jaw Exercise and Manual Therapy 336 49.7.3 Acupuncture 336 49.7.4 Pharmacotherapy 337 49.7.5 Occlusal Stabilising Splint Therapy 337 49.7.6 Anterior Repositioning Splint 337 49.7.7 Occlusal Adjustment 337 49.7.8 TMJ Lavage 337 49.7.9 Surgery 337 References 338 50 Tooth Wear 341 50.1 Definitions and Clinical Features 341 50.2 Aetiology 341 50.2.1 Parafunction and Occlusion 341 50.2.2 Intrinsic Acids 341 50.2.3 Extrinsic Acids 342 50.3 Prevalence 342 50.4 Classification 342 50.5 History and Examination 343 50.6 Prevention 343 50.7 Management of Worn Teeth 343 50.7.1 Conformative Approach 343 50.7.2 Reorganisation Approach 343 50.7.3 Occlusal Splint Therapy Prior to VD Increase 344 50.7.4 Fixed Restorations 344 50.7.4.1 Direct Fixed Restorations 344 50.7.4.2 Indirect Fixed Restorations 344 50.7.5 Crown Lengthening 345 50.7.6 Removable Treatment Options 345 50.7.7 Maintenance 346 References 350 Index 355
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