E-Book, Englisch, 544 Seiten, ePub
Reihe: Color atlas dent med
E-Book, Englisch, 544 Seiten, ePub
Reihe: Color atlas dent med
ISBN: 978-3-13-257851-7
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark
This new edition has been updated to include new developments in every aspect of the field, including etiology and pathogenesis, oral manifestations and treatment of HIV infection, diagnostic tests, advanced conservative and surgical therapies, including guided tissue regeneration, newest systemic and local slow-release drugs, implants to augment dental therapy, mucogingival plastic surgery in halting recession, and the newest classifications of periodontal disease.
Special features:
- All important information presented in a clear and user-friendly format - Nearly 2,000 full-color, clearly labeled photographs for immediate identification of pathologies and treatment techniques - All therapies described and illustrated step-by-step - Tips and tricks from the experts to avoid complications and treatment failure
More than a decade in preparation, this magnificently detailed work is a must for every practitioner and student of periodontics. It incorporates exciting new findings that have immediate clinical applicability, and will be a treasured resource in every practice.
Zielgruppe
Ärzte
Autoren/Hrsg.
Fachgebiete
Weitere Infos & Material
Fundamentals
Introduction
Structural Biology
Etiology and Pathogenesis
Microbiology
Pathogenesis—Reactions and Defense Capabilities of the Host
Indices
Epidemiology
Disease Entities and Diagnosis
Types of Plaque-associated Periodontal Diseases
Gingivitis
Ulcerative Gingivitis/Periodontitis
Hormonally Modulated Gingivitis
Periodontitis
Oral Pathologic Alterations of Gingiva and Periodontium
HIV Infection—AIDS
Gingival Recession
Data Collection—Diagnosis—Prognosis
Additional Diagnosis—Tests
Microbial Diagnosis—Test Methods
Tests of the Host Response—Risks
Prevention—Prophylaxis
Therapy
Treatment of Inflammatory Periodontal Diseases
Periodontal Wound Healing
Systemic Pre-phase
Emergency Treatment
Phase 1 Therapy
Initial Treatment 1—Oral Hygiene by the Patient
Initial Therapy 1—Creating Conditions that Enhance Oral Hygiene
Phase 1 Therapy
FMT—"Full Mouth Therapy"
Medication
Phase 2 Therapy Periodontal Surgery—Corrective Phase
Flap Procedures—Open Treatment
"Access Flap" Surgery, Open Flap Debridement (OFD)—Modified Widman Flap (MWF)
Regenerative Methods
Resective Methods Pocket Elimination—Osseous Surgery
Gingivectomy and Gingivoplasty
Furcation Involvement—Furcation Treatment
Mucoginigval, Plastic Surgery
Covering Areas of Recession
Covering Areas of Recession with a Connective Tissue Graft
Covering Areas of Recession via "Guided Tissue Regeneration"—(GTR)
Periodontics—Endodontics
Phase 3 Therapy Periodontal Maintenance Therapy—Recall
Supporting Therapies
Function-Functional Therapy
Orthodontics
Splinting-Stabilization
Perio-Prosthetics 1 Standard Techniques
Perio-Prosthetics 2 Supplemental Measures, Esthetics
Dental Implants—Implant Therapy
Appendices
Geriatric Periodontology?—The Periodontium in the Elderly
Classification of Periodontal Diseases
Introduction
“Periodontology” is the study of the tooth-supporting tissues, the “periodontium.” The periodontium is made up of those tissues that surround each tooth and which anchor each tooth into the alveolar process (Latin: para = adjacent to; Greek: odus = tooth). The following soft and hard tissues constitute the structure of the periodontium: • Gingiva • Periodontal Ligament • Root Cementum • Alveolar Bone The structure and function of these periodontal tissues have been extensively researched (Schroeder 1992). Knowledge of the interplay between and among the cellular and molecular components of the periodontium leads to optimum therapy, and also helps to establish the goals for future intensive research. Periodontal Diseases
Gingivitis – Periodontitis There are numerous diseases that affect the periodontium. By far the most important of these are plaque-associated gingivitis (gingival inflammation without attachment loss) and periodontitis (inflammation-associated loss of periodontal supporting tissues). • Gingivitis is limited to the marginal, supracrestal soft tissues. It is manifested clinically by bleeding upon probing of the gingival sulcus, and in more severe cases by erythema and swelling, especially of the interdental papillae (Fig. 3). • Periodontitis can develop from a pre-existing gingivitis in patients with compromised immune status, the presence of risk factors and pro-inflammatory mediators, as well as the presence of a predominately periodontopathic microbial flora. The inflammation of the gingiva may then extend into the deeper structures of the tooth-supporting apparatus. The consequences include destruction of collagen and loss of alveolar bone (attachment loss). The junctional epithelium degenerates into a “pocket” epithelium, which proliferates apically and laterally. A true periodontal pocket forms. Such a pocket is a predilection site and a reservoir for opportunistic, pathogenic bacteria; these bacteria sustain periodontitis and enhance the progression of the disease processes (Fig. 4). Gingival Recession Gingival recession is not actually a “disease,” but rather an anatomic alteration that is elicited by morphology, improper oral hygiene (aggressive scrubbing), and possibly functional overloading. • Teeth are not lost due to classical gingival recession, but patients may experience cervical hypersensitivity and esthetic complications. If gingival recession extends to the mobile oral mucosa, adequate oral hygiene is often no longer possible. Secondary inflammation is the consequence. In addition to classical gingival recession, apical migration of the gingiva is often observed in patients with longstanding, untreated periodontitis, and it may be a consequence of periodontitis therapy in elderly patients (“involution”; Fig. 2). These three periodontal disorders – gingivitis, periodontitis, gingival recession – are observed world-wide; they affect almost the entire population of the earth to greater or lesser degree. In addition to these common forms of oral pathology, there are many less frequently encountered diseases and defects of the periodontal tissues. All of these diseases were comprehensively classified at an international World Workshop in 1999 (see Appendix, p. 519). 1 Healthy Periodontium The most important characteristic of the periodontium is the special connection between soft and hard tissues: • In the marginal region, one observes the inflammation-free gingiva, which provides the epithelial attachment to the tooth by means of its junctional epithelium (pink collar). This connection protects the deeper-lying components of the periodontium from mechanical and microbiologic insult. • Subjacent to the junctional epithelium, one observes the supracrestal fibers, which serve to connect the tooth with the gingiva, and also the periodontal ligament fibers in the region of the alveolar bone, which insert into the bone and the cementum of the root surface. Prevention of disease: Maintaining the health of the periodontium is the highest goal in periodontology, and should also be the patient's goal. It is achieved by optimum, purely mechanical oral hygiene. Disinfectant mouth-washes may enhance mechanical hygiene. 2 Gingival Recession The main characteristic of this condition, which is often esthetically objectionable to patients, is an inflammation-free apical migration of the gingival margin. A morphological prerequisite is generally a facial bony lamella that is either extremely thin or entirely lacking. Gingival recession can be initiated and propagated by improper traumatic tooth brushing (horizontal scrubbing), and functional overloading may also play a role (?). Thus gingival recession cannot be classified as a true periodontal disease. The best way for a patient to prevent gingival recession is by using an adequate but gentle oral hygiene technique (vertical-rotatory brushing or use of a sonic toothbrush). Treatment: Incipient or progressing gingival recession can be halted by altering the patient's oral hygiene techniques; in severe cases, mucogingival surgery may be employed to stop the progression or re-cover the exposed root surfaces. 3 Gingivitis Gingivitis is characterized by plaque-induced inflammation of the papillary and marginal gingivae. Clinical symptoms include bleeding on probing, erythema, and eventual swelling. Gingivitis may be more or less pronounced depending upon the plaque—a biofilm—(quantity/quality) and the host response. Deeper lying structures (alveolar bone, periodontal ligament) are not involved. Gingivitis may be a precursor to periodontitis, but this does not always occur. Treatment: Gingivitis can be completely controlled simply through adequate plaque control. Following initiation or improvement of oral hygiene procedures, coupled with professional plaque and calculus removal, complete healing can be expected. Nevertheless, freedom from inflammation, e. g., absence of bleeding on probing, will be impossible to achieve if the patient is not capable of maintaining a high standard of oral hygiene over the long term, or is not willing to do so (compliance!). 4 Periodontitis At the gingival margin, the characteristics of periodontitis are similar to those of gingivitis, but the inflammatory processes extend further, into the deeper-lying periodontal structures (alveolar bone and periodontal ligament). True periodontal pockets are formed and connective tissue attachment is lost. Loss of hard and soft tissues is usually localized and not generalized. Periodontitis may be classified as chronic (Type II) or aggressive (Type III), with varying degrees of severity. Approximately 90 % of all cases are characterized as “chronic periodontitis” (p. 108, 519). Treatment: Most cases of periodontitis can be treated successfully. However, the required therapeutic endeavor can vary enormously from case to case. The treatment effort may be relatively small in early stages of periodontitis. Mechanical treatment remains today in the foreground. In special cases, topical and systemic medications may be used as supportive therapy. The Clinical Course of Untreated Periodontitis
Periodontitis is usually a very slowly progressing disease (Locker & Leake 1993; Albandar et al. 1997), which in severe cases—particularly when untreated—can lead to tooth loss. Enormous variation in the speed of progression of periodontitis is observed when one differentiates between individual patients. In addition to the quantity and composition of the bacterial plaque, individually varying influences also play important roles: the systemic health of the patient, the patient's genetic constitution, psychically influenced immune response status, ethnic and social factors, as well as risk factors such as smoking and stress (p. 22, Fig. 41). All of these circumstances can influence the onset and the speed at which the disease process accelerates in different patient age groups. Not all teeth or individual surfaces of teeth are equally susceptible (Manser & Rateitschak 1996): • Molars are the most endangered • Premolars and anterior teeth are less susceptible • Canines are the most resistant. 5 Clinical Course of Untreated Periodontitis In the aggressive forms of periodontitis (pp. 95, 97), the manifestation of tissue loss on individual teeth occurs in successive acute phases rather than in a gradual, chronic progression. Phases of progression and quiescence alternate. Destructive phases may occur rapidly one after another, or longer quiescent phases may be in evidence. Red Acute phase/destruction Blue Phase of quiescence Periodontitis—Concepts of Therapy
The primary goal is prevention of periodontal...
