Contemporary Periodontal Surgery : An Illustrated Guide to the Art Behind the Science

This book aims to provide an evidence-based and highly illustrative approach to a comprehensive repertoire of surgical procedures, including: basic principles, resective surgery, regenerative techniques and periodontal/peri-implant plastic surgery. It emphasizes the importance of case selection and planning to successful outcomes and extols the benefits of microsurgical instrumentation. The distinction between periodontal and other forms of oral surgery is made, principally that in periodontal surgery, the contour and quality of the tissues post-operatively is vital to longer-term success and therefore careful soft tissue management is pivotal. Title Page 2 Copyright Page 4 Table of Contents 5 Foreword 13 Preface 14 Acknowledgements 17 Chapter 1: Principles and Practice of Periodontal Surgery 1: Case Selection and Planning 18 Aim 18 Outcome 18 The Art and Science of Surgery 18 The Right Procedure 19 The Right Patient 19 Preoperative Management 21 Record-Keeping 21 Antimicrobial Chemotherapy 22 Analgesia 23 Surgical Analgesia and Haemostasis 23 Operative Management 25 Post-operative Management 26 Achieving Post-operative Haemostasis 26 Analgesia 27 Post-operative Instructions 29 Review Visit 29 References 30 Further Reading 31 Chapter 2: Principles and Practice of Periodontal Surgery 2: Basic Surgical Principles 32 Aim 32 Outcome 32 Introduction 32 Tenets of Halsted 33 Operative Management 33 Flap Design 34 Incision 40 Reflection 43 Retraction 45 Bone Management 46 Flap Compression and Closure 48 References 52 Further Reading 52 Chapter 3: Surgical Management of Gingival Overgrowth 53 Aim 53 Outcome 53 Introduction 53 Drug-induced Gingival Overgrowth 54 Inflammatory Gingival Overgrowth 56 Epulides 58 Hereditary Gingival Fibromatosis 58 Presurgical Management 60 Reasons for Surgical Intervention 60 Some Medical Considerations 61 Surgical Management 61 Gingivectomy 62 Inverse Bevel Incisions for Tissue Debulking 68 Epulis Excision 76 Wedge Excision 77 Periodontal Dressings 81 Maintenance 81 Further Reading 82 Chapter 4: Access Flaps for Surgical Root Surface Debridement 83 Aim 83 Outcome 83 Introduction 83 Presurgical Management 85 Aggressive Periodontitis 86 Surgical Management 87 Objectives of Surgical Root Surface Debridement 87 Simple Replaced Flap (Envelope Flap) 88 The Modified Widman Flap 95 Suturing 97 The Use of a Periodontal Pressure Dressing 100 Post-operative Instructions 100 Review 100 Periodontal Maintenance 100 Key Points 101 References 101 Further Reading 102 Chapter 5: Regenerative Periodontal Techniques 103 Aim 103 Outcome 103 Introduction 103 Terminology 106 Biological Principles Underpinning GTR 107 Surgical Planning for Membrane GTR 113 Indications 113 Contraindications 114 What Went Wrong in Practice and Why? 114 Objectives of GTR surgery 115 Criteria for Success 115 The Need for Two-stage Surgery 115 Case Selection and Planning 116 The Surgical Phase 117 Post-operative Care 122 The Outcome of GTR 122 Modifications to the Original Membranes 123 Resorbable GTR membranes 124 Enamel Matrix Proteins (Emdogain) 128 Bone Grafting and Bioceramic Bone Substitutes 134 Cocktail Procedures 137 Growth Factors 137 Guided Bone Regeneration 138 Key Points 145 References 146 Further Reading 147 Chapter 6: Periradicular Surgery 148 Aim 148 Outcome 148 Introduction 148 Orthograde Retreatment or Periradicular Surgery? 149 Case Selection 152 Indications for Periradicular Surgery 152 Contraindications for Periradicular Surgery 153 Holistic Restorative Treatment Planning 153 Tooth-specific Assessment 153 Site-specific Surgical Contraindications 153 Alternative Treatment Options and their Predictability 153 Operator-related Factors 154 Patient-related Factors 154 Pre-surgical preparation 154 Presurgical Endodontics 154 Informed Consent 155 The Surgical Phase 155 Analgesia 156 Flap Design 157 Incision 161 Reflection 161 Root End Identification and Curettage 162 Root End Resection 162 Crypt Control 165 Root-end Preparation 167 Root-end Restoration 170 Closure 174 Post-surgical Management 175 Key Points 175 Further Reading 176 Chapter 7: Resective Hard Tissue Surgery 177 Aim 177 Outcome 177 Introduction 177 Examination, diagnosis and treatment planning 178 Indications for Root Amputation/Resection and Hemisection 181 Contraindications to Resective Surgery 186 Assessment of Teeth for Resective Surgery 186 Tooth-specific Assessment 187 General Assessment 188 Procedure 189 Presurgical Preparation 189 Furcation Plasty 190 Tunnelling 190 Root Amputation and Hemisection 191 Definitive Restoration 198 Maintenance 207 Key Points 209 Further Reading 209 Chapter 8: Crown-lengthening Surgery 211 Aim 211 Outcome 211 Introduction 211 Biological Width 212 Case Selection 213 Indications for Croum-lengthening Surgery 213 Contraindications for Croum-lengthening Surgery 214 Presurgical Preparation 215 Tooth Preparation 215 Informed Consent 220 Surgical Procedures 221 Gingivectomy 222 Apically Repositioned Flap Surgery 222 Osseous Reduction 226 Post-surgical Management 228 Key Points 228 References 228 Further Reading 229 Chapter 9: Mucogingival Grafting Procedures – An Overview 230 Aim 230 Outcome 230 Introduction 230 Risk Factors for Gingival Recession 231 Miller’s Classification of Recession 232 Management of Gingival Recession 233 Presurgical Management 233 Indications for Surgical Intervention 234 Case Selection and Outcome-related Factors 235 Preparatory Treatment 236 Root Preparation 238 Surgery 239 Free Soft Tissue Graft Procedures 239 Pedicle Soft-tissue Graft Procedures 251 Post-operative Instructions 254 Creeping Attachment 254 Assessing Outcomes 255 Key Points 256 References 257 Chapter 10: Hard Tissue Surgery (Ridge Augmentation) for Dental Implants 258 Aim 258 Outcome 258 Introduction 258 Operative Management 260 Bone Augmentation Procedures for the Anterior Maxilla 260 Bone Augmentation Procedures for the Posterior Maxilla 264 Bone Augmentation Procedures for the Mandible 266 Factors Affecting Success 266 Key Points 267 References 268 Further Reading 268 Chapter 11: Soft Tissue Surgery Around Dental Implants 269 Aim 269 Outcome 269 Introduction 269 Peri-implant Soft Tissue Characteristics 269 Implants Do Not Have a Periodontal Ligament 271 Implant Components Affect Soft Tissue Behaviour 271 Soft Tissue Quality 272 Mucogingival Procedures Around Implants 273 Types of Peri-implant Surgical Procedures 274 Timing of Surgical Procedures Around Implants 274 Free Epithelialised Soft Tissue Graft 275 Recipient Site Preparation 277 Epithelialised Graft Harvest from Hard Palate (Fig 11-3a—d) 277 Graft Modification 280 Insetting the Graft 281 Grafting at Second Stage Surgery 281 Late Procedures 283 Free Connective Tissue Grafts 285 Local Peri-implant Flap Procedures 286 Simple Flap Adaptation 287 Semi-submerged Healing 288 Tissue Punch Exposure 289 Palatal “U” Flap Exposure 290 Papilla Creation Technique 291 The Roll Flap 292 Key Points 293 References 294 Further Reading 294 HauptbeschreibungThis highly illustrative book provides a comprehensive repertoire of surgical procedures, including basic principles, resective surgery, regenerative techniques, and periodon tal/peri-implant plastic surgery.(Quintessence Publishing / Quintessenz Verlag)