Chapter 88 Atlas of Periodontal Diseases

C H A P T E R 8 8
Atlas of Periodontal
M. Cenk Haytac, Onur Ucak Turer
Plaque-Induced Gingival Diseases
Causes of Periodontal Diseases
Gingival Diseases Modified by Systemic Factors
Gingival Diseases Associated With Blood Dyscrasias
Drug-Induced Gingival Diseases
Non–Plaque-Induced Gingival Lesions
Gingival Lesions of Genetic Origin
Gingival Manifestations of Systemic Conditions
Traumatic Lesions: Factitious, Iatrogenic, and Accidental
Cysts and Tumors
Chronic Periodontitis
Aggressive Periodontitis
Periodontitis as a Manifestation of Systemic Diseases
Genetic Disorders
Necrotizing Periodontal Diseases

Abscesses of Periodontium
This chapter provides additional illustrations for Chapter 27 and
the chapters in Part 2 and in Sections 1 and 2 of Part 3. The
presentation of cases follows the classification of periodontal
diseases and conditions developed by the 1999 International
Workshop for the Classification of Periodontal Diseases, which was
organized by the American Academy of Periodontology (see
Chapter 4). All illustrations are from the Archives of the
Department of Periodontology, School of Dentistry, Cukurova
University, Adana, Turkey (Box 88.1).
Box 88.1
Gingival Diseases
Plaque-Induced Gingival Diseases
I. Gingivitis associated with dental plaque only
A. Without local contributing factors
B. With local contributing factors (see Figs. 88.1 to 88.32)
II. Gingival diseases modified by systemic factors
A. Associated with endocrine system
1. Puberty-associated gingivitis (see Fig.
2. Menstrual cycle–associated gingivitis (see
Fig. 88.34)
3. Pregnancy-associated gingivitis (see Figs.
88.35 to 88.37)
a. Gingivitis
b. Pyogenic granuloma
4. Diabetes mellitus–associated gingivitis
B. Associated with blood dyscrasias
1. Leukemia-associated gingivitis (see Figs.
88.38 to 88.40)

2. Other (see Figs. 88.41 to 88.46)
III. Gingival diseases modified by medications
A. Drug-induced gingival diseases
1. Drug-influenced gingival enlargement (see
Figs. 88.47 to 88.51)
2. Drug-influenced gingivitis
a. Oral contraceptive–associated
b. Other
IV. Gingival diseases modified by malnutrition
A. Ascorbic acid–deficiency gingivitis
B. Other
Non–Plaque-Induced Gingival Lesions
I. Gingival diseases of specific bacterial origin
A. Neisseria gonorrhoeae
B. Treponema pallidum
C. Streptococcus species (see Fig. 88.52)
D. Other
II. Gingival diseases of viral origin
A. Herpesvirus infection (see Fig. 88.53)
1. Primary herpetic gingivostomatitis
2. Recurrent oral herpesvirus infection
3. Varicella zoster
B. Other (see Fig. 88.54)
III. Gingival diseases of fungal origin
A. Candida species infections: generalized gingival
candidiasis (see Figs. 88.55 and 88.56)
B. Linear gingival erythema
C. Histoplasmosis
D. Other (see Figs. 88.57 and 88.58)
IV. Gingival lesions of genetic origin
A. Hereditary gingival fibromatosis (see Figs. 88.59 to
B. Other
V. Gingival manifestations of systemic conditions

A. Mucocutaneous lesions
1. Lichen planus (see Figs. 88.62 to 88.65)
2. Pemphigoid
3. Pemphigus vulgaris (see Fig. 88.66)
4. Erythema multiforme
5. Lupus erythematosus
6. Drug induced
7. Other (see Figs. 88.67 to 88.73)
B. Allergic reactions
1. Dental restorative materials
a. Mercury
b. Nickel
c. Acrylic
d. Other
2. Reactions attributable to the following
a. Toothpastes or dentifrices
b. Mouthrinses or mouthwashes
c. Chewing gum additives
d. Foods and additives (see Fig.
3. Other
VI. Traumatic lesions: factitious, iatrogenic, or accidental (see
Figs. 88.75 to 88.92)
A. Chemical injury
B. Physical injury
C. Thermal injury
VII. Foreign body reactions
VIII. Not otherwise specified
A. Cysts and tumors (see Figs. 88.93 to 88.102)
Chronic Periodontitis (see Figs. 88.103 to 88.108)
I. Localized
II. Generalized
III. Chronic periodontitis modified by systemic disorders
A. Diabetes mellitus (see Figs. 88.109 to 88.113)

Aggressive Periodontitis (see Figs. 88.114 to 88.119)
I. Localized
II. Generalized
Periodontitis as a Manifestation of Systemic Diseases
I. Hematologic disorders
A. Acquired neutropenia
B. Leukemias (see Figs. 88.120 to 88.122)
C. Other
II. Genetic disorders
A. Familial and cyclic neutropenia (see Fig. 88.123)
B. Down syndrome
C. Leukocyte adhesion deficiency syndromes (see Figs.
88.124 and 88.125)
D. Papillon-Lefèvre syndrome (see Figs. 88.126 and
E. Chediak-Higashi syndrome
F. Histiocytosis syndromes
G. Glycogen storage disease
H. Infantile genetic agranulocytosis
I. Cohen syndrome
J. Ehlers-Danlos syndrome (types 4 and 8)
K. Hypophosphatasia (see Fig. 88.128)
L. Other
III. Not otherwise specified
Necrotizing Periodontal Diseases
I. Necrotizing ulcerative gingivitis (NUG) (see Figs. 88.129 to
II. Necrotizing ulcerative periodontitis (NUP) (see Fig. 88.132)
III. Bisphosphonate-related osteonecrosis (see Figs. 88.133 and
Abscesses of the Periodontium

I. Gingival abscess
II. Periodontal abscess (see Figs. 88.135 to 88.137)
III. Pericoronal abscess (see Fig. 88.138)
Periodontitis Associated With Endodontic Lesions
I. Endodontic-periodontal lesions (see Figs. 88.139 and 88.140)
II. Periodontal-endodontic lesions
III. Combined lesions
Developmental or Acquired Deformities and Conditions
I. Localized tooth-related factors
II. Mucogingival deformities around teeth
III. Mucogingival deformities on edentulous ridges
IV. Occlusal trauma
Plaque-Induced Gingival Diseases
Clinical Features of Gingivitis
Color Changes
Surface Texture

FIG. 88.1 In the healthy gingiva of a 17-year-old girl,
notice the demarcation (mucogingival line) (arrows)
between the attached gingiva and the darker alveolar
FIG. 88.2 Two views show prominent stippling of
healthy gingiva in a 21-year-old man.

FIG. 88.3 Bright-red color and loss of stippling of the
gingiva is seen in a 21-year-old woman with gingivitis.
FIG. 88.4 Two views show bleeding on probing in a
24-year-old man with gingivitis and inflammatory

FIG. 88.5 Plaque accumulation and red color of the
gingiva are seen in a 17-year-old girl with gingivitis.
FIG. 88.6 Bluish red color of the gingiva is seen in a
46-year-old man with advanced chronic periodontitis.
Melanin Pigmentation

FIG. 88.7 Two views show melanin pigmentation that
caused aesthetic problems in a 21-year-old woman
and the gums 6 months after treatment with a carbon
dioxide laser.
FIG. 88.8 Two views show diffuse melanin
pigmentation that caused aesthetic problems for a 34-
year-old woman and the gums 2 months after
treatment with conventional gingivectomy.

FIG. 88.9 Two views show localized melanin
pigmentation in a 26-year-old woman and the result 1
month after treatment with a carbon dioxide laser.

FIG. 88.10 Two views show diffuse localized melanin
pigmentation in a 33-year-old woman and the result 1
month after carbon dioxide laser treatment.
Causes of Periodontal Diseases
Microbial Dental Plaque
One-Sided Chewing

Mouth Breathing
FIG. 88.11 Severe plaque accumulation and gingivitis
occurred in a 13-year-old boy with neglected hygiene.
FIG. 88.12 Extensive plaque formed in a 46-year-old
man with chronic periodontitis. Darker shades of
gingiva are seen in areas with subgingival calculus.

FIG. 88.13 Three views show extreme plaque
formation and periodontitis in a 52-year-old woman
with prolonged neglect of oral hygiene procedures.
FIG. 88.14 Plaque formation was caused by habitual

one-sided chewing in a 9-year-old boy. The patient had
avoided chewing on the right side because of the
mobility of deciduous teeth.
FIG. 88.15 There is extensive plaque accumulation
and severe inflammation in a 35-year-old male smoker.
FIG. 88.16 Advanced plaque and calculus formed
around implants in a 72-year-old woman.

FIG. 88.17 Plaque and calculus formed around
implants in a 55-year-old man.
FIG. 88.18 Three views show calculus formation on
teeth #26 and #27 where the parotid gland duct (i.e.,
Stensen duct) opens in a 47-year-old man. These
teeth had lost their functional antagonists. Calculus
also covered the occlusal surfaces.

FIG. 88.19 Calculus formed on upper molars adjacent
to the Stensen duct in a 44-year-old man. Notice the
divergence of the roots of the first molar.
FIG. 88.20 Anterior open-bite malocclusion and the
loss of functional antagonist teeth caused extensive
calculus formation on the left maxillary teeth in this 35-
year-old woman.

FIG. 88.21 Bridge-like formations of calculus resulted
from malocclusion, loss of an antagonist tooth, tilting of
the remaining teeth, and avoidance of chewing on the
affected site in a 49-year-old woman.
FIG. 88.22 Two views show extensive calculus that
formed adjacent to the Stensen duct in a 53-year-old

FIG. 88.23 Extensive bridge-like calculus formed on
the lingual surfaces of the lower anterior teeth where
the Wharton and Bartholin ducts empty in a 36-year-
old man.

FIG. 88.24 (A) Extensive bridge-like calculus formed
on the lingual surfaces of the lower anterior teeth
where the Wharton and Bartholin ducts empty in a 42-
year-old woman. (B) In the same patient seen in A
after extraction of the left central incisor, calculus has
covered almost all surfaces of the tooth.
FIG. 88.25 A radiograph shows the radiopaque
projection of extensive calculus, which is compared
with its appearance after extraction in a 62-year-old

FIG. 88.26 Three views show the extreme plaque and
calculus formation that was caused by habitual one-
sided chewing in a 35-year-old woman. The patient
had avoided chewing on the left side for 10 years.

FIG. 88.27 Extensive plaque and calculus formation
was associated with crowding of the teeth in a 21-year-
old woman.
FIG. 88.28 Periodontal destruction was associated with
class III malocclusion in a 35-year-old man.

FIG. 88.29 Four views show extensive calculus
formation in a 9-year-old child with an open bite and
lack of hygiene.

FIG. 88.30 Two views show plaque formation and
gingival inflammation with crowding and
supernumerary teeth in a 14-year-old boy.
FIG. 88.31 Gingival inflammation and enlargement was

associated with chronic habitual mouth breathing in a
16-year-old boy. There is clear demarcation of the
affected gingiva.
FIG. 88.32 Two views show extensive plaque and
calculus formation in a 27-year-old woman and the
same patient after 2 months of receiving initial
debridement and oral hygiene instruction. Although the
patient still has hygiene problems, the inflammation,
redness, and contour of the gingiva are greatly
Gingival Diseases Modified by
Systemic Factors

Endocrine System
Sex Hormones
FIG. 88.33 Puberty gingivitis in a 14-year-old girl was
associated with poor hygiene, crowding of teeth, and
mouth breathing. Gingival hyperplasia was confined to
the anterior regions.
FIG. 88.34 Periodic localized color changes of the
gingiva around maxillary anterior teeth were
associated with menstruation in a 29-year-old woman.

FIG. 88.35 Localized gingival enlargement occurred in
a 24-year-old woman who was in the seventh month of
pregnancy. The lesion was first noticed in the fourth
month by the patient.
FIG. 88.36 Severe gingival enlargement occurred in a
29-year-old woman who was 8 months pregnant.

FIG. 88.37 Gingival enlargement in a 32-year-old
woman in the (A) seventh, (B) eighth, and (C) ninth
months of pregnancy and (D) at 1 month after delivery.
Notice the progression of the dimensions and the
increase of the vascularization of the lesion. (E) The
extraoral view shows the lesion interfering with
occlusion and aesthetics.
Gingival Diseases Associated With
Blood Dyscrasias

FIG. 88.38 Two views show gingival hyperplasia and
spontaneous bleeding (left) in a 6-year-old boy with
newly diagnosed acute myelogenous leukemia and
after one course of chemotherapy and periodontal
treatment (right).
FIG. 88.39 Enlargement of the gingiva and floor of the
mouth occurred in an 8-year-old boy with acute
myelogenous leukemia.

FIG. 88.40 Severe gingival inflammation, hyperplasia,
and the results of poor hygiene are seen in a 46-year-
old man with chronic myelogenous leukemia.
FIG. 88.41 Pale gingiva and apparent vascular
structures are seen in a 22-year-old woman with iron
deficiency anemia.

FIG. 88.42 Severe malocclusion and gingival recession
occurred in an 18-year-old boy with thalassemia.
FIG. 88.43 Skeletal disturbance of the thumb (left) and
severe gingival inflammation with spontaneous
bleeding (right) occurred in a 12-year-old boy with
Fanconi anemia.

FIG. 88.44 Localized bleeding occurred in the tissue in
a 24-year-old woman with Glanzmann thrombasthenia.
FIG. 88.45 Plaque accumulation and spontaneous
bleeding occurred in a 28-year-old patient with
hemophilia A who neglected oral hygiene procedures
due to severe bleeding.

FIG. 88.46 Spontaneous bleeding and clot formation
occurred in a 22-year-old man with von Willebrand
Drug-Induced Gingival Diseases
FIG. 88.47 Gingival enlargement was associated with
phenytoin use in a 20-year-old patient with epilepsy.

FIG. 88.48 Amlodipine-associated gingival
enlargement was seen in a 47-year-old man with
FIG. 88.49 Gingival enlargement occurred in a 44-
year-old man receiving cyclosporine after kidney

FIG. 88.50 (A) In a case of cyclosporine-associated
gingival enlargement, the clinical crowns are covered
and enlargement reaches up to the occlusal plane. (B)
Intraoperative view of the enlargement. Views of the
patient after (C) 6 and (D) 12 months. (From Haytac CM, Ustun
Y, Essen E, Ozcelik O: Combined treatment approach of gingivectomy and CO2
laser for cyclosporine-induced gingival overgrowth. Quintessence Int 38(1):e54-
e59, 2007.)

FIG. 88.51 Gingival thickening and hyperplasia
occurred in a 25-year-old male bodybuilder who had
been using steroid injections for 3 years.
Non–Plaque-Induced Gingival Lesions
Streptococcus Species Infections
FIG. 88.52 Lesions on the lip and gingiva are seen in a
7-year-old child with acute streptococcal

Herpesvirus Infections
FIG. 88.53 Ruptured and unruptured herpetic vesicles
(arrows) are seen in a 19-year-old male with herpetic
FIG. 88.54 Two views show recurrent aphthous ulcers
in a 27-year-old woman.
Gingival Diseases of Fungal Origin

FIG. 88.55 Four views show severe mucositis on the
gingiva, cheek, palatal mucosa, and tongue of a 7-
year-old boy with acute myelogenous leukemia after
remission induction chemotherapy. These lesions are
very prone to candidal infections.

FIG. 88.56 Candidal infection of the oral cavity
occurred after chemotherapy in a 3-year-old boy with
acute myelogenous leukemia.
FIG. 88.57 Mucormycosis caused soft and hard tissue
destruction in a 9-year-old patient with acute
myelogenous leukemia.

FIG. 88.58 (A) Two views show rapid gingival and
alveolar bone destruction caused by mucormycosis
infection in a 14-year-old boy with acute myelogenous
leukemia. The lesions started on the third day of
chemotherapy, and breakdown occurred within 1
week. (B) Histologic analysis used Gomori
methenamine silver staining, which showed fungal
hyphae. (Courtesy Dr. M. Cem Dogan and Dr. M. Cenk Haytac.)
Gingival Lesions of Genetic Origin
Hereditary Gingival Fibromatosis

FIG. 88.59 Hereditary gingival fibromatosis occurred in
a family. Intraoral views of the father were obtained in
(A) 2000, (B) 2003, and (C) 2005.

FIG. 88.60 Hereditary gingival fibromatosis occurred in
a family. In four views of the father in 2000, notice the
severe enlargement of the tuberosities contacting the
mandibular ridges and the root fragments in the
overgrown tissue.

FIG. 88.61 Hereditary gingival fibromatosis occurred in
a family. Intraoral views of the younger son show his
condition when he was (A) 10 days and (B) 2 years
old. (From Haytac MC, Ozcelik O: The phenotypic overlap of syndromes
associated with hereditary gingival fibromatosis: follow-up of a family for five years.
Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 103:521–527, 2007.)
Gingival Manifestations of Systemic
Mucocutaneous Lesions

FIG. 88.62 Severe desquamation and positive Nikolsky
sign were seen in a 56-year-old woman with lichen
planus. Desquamation leaves the connective tissue
exposed and painful in response to stimulant agents.

FIG. 88.63 Two views show reticular lichen planus in a
63-year-old woman who was referred because of a
complaint of a burning sensation in her mouth.

FIG. 88.64 Two views show desquamation and
spontaneous bleeding in a 62-year-old woman with
erosive lichen planus. The patient was extremely
sensitive to temperature changes and foods.

FIG. 88.65 Two views show atrophic lichen planus that
exposed connective tissue in a 62-year-old man.

FIG. 88.66 Three views show pemphigus vulgaris
characterized by desquamation, pain, and bleeding in
a 56-year-old woman. The suprabasal and
subepithelial separation of cells can be detected in the
histologic analysis.
Other Systemic Diseases

FIG. 88.67 Four views show developmental deformities
of the fingers and limited mouth opening in an 18-year-
old boy with scleroderma. Insufficient attached gingival
width complicates oral hygiene procedures, and
advanced gingival recession is seen on the lower
central incisor.
FIG. 88.68 Gingival enlargement occurred in a 9-year-
old boy with juvenile hyaline fibromatosis.

FIG. 88.69 Four views show atopic dermatitis
characterized by pruritic lesions on the extremities and
lips of a 22-year-old woman. Notice the inadequate
vestibular depth and gingival recession.

FIG. 88.70 Five views show fibrous dysplasia
characterized by unilateral fibroosseous expansion of
the bones in a 17-year-old girl. Notice the facial
asymmetry, advanced malocclusion, migration of teeth
starting from the midline, and gingival enlargement in
accordance with expansion of the underlying bones.
The radiograph shows unilateral increases of the
dimensions of mandible and maxilla.

FIG. 88.71 Three views show Sturge-Weber syndrome
characterized by unilateral cavernous hemangiomas
on the face and neck of a 35-year-old man. Notice the
unilateral soft tissue and easily bleeding gingival
enlargement with high vascularization on the affected

FIG. 88.72 Three views show Rothmund-Thomson
syndrome characterized by photosensitivity and
hypopigmentation and hyperpigmentation on the skin
of a 16-year-old girl. Notice the decreased
keratinization and spontaneous bleeding of the gingiva.
Histologic analysis showed discontinuity of the
basement membrane. (From Haytac MC, Oztunç H, Mete UO, Kaya M:
Rothmund-Thomson syndrome: a case report. Oral Surg Oral Med Oral Pathol
Oral Radiol Endodontol 94:479–484, 2002.)

FIG. 88.73 Four views show recurrent major aphthous
lesions on the cheek and lip mucosa, tongue, and
alveolar mucosa in a 42-year-old man with Behçet

FIG. 88.74 Four views show results of the oral
challenge test for the diagnosis of an allergic reaction
of the gingiva to apples in a 48-year-old woman. Notice
the formation of blisters, desquamation, and
subepithelial bleeding. (From Haytac MC, Ozcelik O: Oral challenge
test for the diagnosis of gingival hypersensitivity to apple: a case report. Oral Surg
Oral Med Oral Pathol Oral Radiol Endodontol 101:317–321, 2006.)
Traumatic Lesions: Factitious,
Iatrogenic, and Accidental
FIG. 88.75 Inadequate margins, design, and shape of
the restoration violating the biologic width caused
severe gingival inflammation in a 32-year-old woman.

FIG. 88.76 Overhanging margins and injury were
caused by the self-curing acrylic used for restoration in
a 49-year-old woman.

FIG. 88.77 Three views show extensive calculus
formation and an ill-fitting restoration on the lower
anterior teeth of a 51-year-old man. Notice the trauma
caused by the deposits on the sublingual soft tissue
seen after the restoration was removed.

FIG. 88.78 Two views show extensive calculus
formation under the restoration on the lower anterior
teeth of a 44-year-old man. Notice the trauma caused
by calculus on the sublingual soft tissue seen after
FIG. 88.79 Subgingival margin locations and lack of

interproximal embrasures of the crowns caused
gingival inflammation in a 29-year-old man.
FIG. 88.80 Two views show the results of misuse of
ferric sulfate during gingival retraction, which caused
burns and desquamation in a 30-year-old man.
FIG. 88.81 Two views show iatrogenic use of a
bonding agent for the treatment of dentinal
hypersensitivity, causing gingival recession in a 32-
year-old woman.

FIG. 88.82 Trauma and inflammation of the soft tissues
was caused by the brackets in a 14-year-old
orthodontic patient.
FIG. 88.83 Gingival trauma was caused by the ligature
wire in a 12-year-old girl.

FIG. 88.84 Gingival recession was associated with
vigorous toothbrushing in a 48-year-old man.
FIG. 88.85 Gingival desquamation after a 21-year-old
woman rinsed with cologne.

FIG. 88.86 Hyperkeratosis was associated with
smokeless tobacco use in a 42-year-old man.
FIG. 88.87 Desquamation was associated with
toothbrushing with soap in a 55-year-old man.

FIG. 88.88 Trauma and desquamation occurred after
placing plant seeds on the gingiva for a toothache in a
41-year-old man.
FIG. 88.89 Gingival recession was associated with
habitual scratching of the gingiva with a nail in a 26-
year-old woman.

FIG. 88.90 Gingival recession was associated with
habitual cleansing with tissue in a 42-year-old woman.
FIG. 88.91 Desquamation and burn occurred after a
50-year-old man rinsed with raki, a Turkish drink with a
40% to 50% alcohol content.

FIG. 88.92 A traumatic lesion resulted from placing
fresh garlic onto the aching third molar in a 26-year-old
Cysts and Tumors
FIG. 88.93 A fibroma in a 45-year-old man had a firm
and nodular character.

FIG. 88.94 Two views show a fibroma in a 56-year-old
man. (Courtesy Dr. Burcu Cam and Dr. Onur Ozcelik.)
FIG. 88.95 A papilloma occurred in a 27-year-old

FIG. 88.96 A papilloma developed on the palatal tissue
in a 42-year-old woman.
FIG. 88.97 Two views show severe, generalized
human papillomavirus–associated warts in a 7-year-old

FIG. 88.98 A peripheral giant-cell granuloma was seen
in a 31-year-old woman.
FIG. 88.99 An ameloblastoma occurred in a 54-year-
old woman.

FIG. 88.100 An ameloblastoma was seen in a 49-year-
old patient.
FIG. 88.101 Squamous cell carcinoma was detected in
a 62-year-old patient.

FIG. 88.102 Malignant melanoma was seen in a 52-
year-old woman.
Chronic Periodontitis

FIG. 88.103 Two views show plaque and calculus that
caused chronic periodontitis in a 42-year-old man
without any systemic diseases. Notice the generalized
radiographic bone loss.

FIG. 88.104 Two views show gingival recession,
mobility, migration, and extrusion of teeth due to
alveolar bone loss in a 48-year-old man with chronic

FIG. 88.105 Advanced chronic periodontitis was seen
in a 54-year-old man who had hygiene neglect and
smoking as contributing factors.
FIG. 88.106 Generalized bone loss occurred in a 38-
year-old woman with moderate chronic periodontitis.

FIG. 88.107 Two views show generalized bone loss
that occurred in a 45-year-old male smoker with
advanced chronic periodontitis.

FIG. 88.108 (A) Cone-beam computed tomography
shows generalized bone loss in a 39-year-old man with
advanced chronic periodontitis. (B) Two views show
the patient before and 4 months after initial periodontal
therapy and extraction of mandibular incisors (bottom).
There is closure of the diastema between the maxillary
central incisors after therapy.

Chronic Periodontitis Modified by Systemic
Diabetes Mellitus
FIG. 88.109 Severe gingival inflammation and
periodontal abscess occurred in a 26-year-old woman
with type 1 diabetes mellitus. Notice the extrusion of
the maxillary left central incisor caused by alveolar
bone loss.
FIG. 88.110 Severe inflammation, pus formation, and

periodontal breakdown occurred in a 34-year-old man
with uncontrolled type 1 diabetes mellitus.
FIG. 88.111 Two views show the dentition of a 14-
year-old girl who was referred with a complaint of tooth
mobility. She had spontaneous loss of teeth #11, #31,

#41, and #46 in the past 2 years. The patient had
advanced bone loss despite a minimal amount of
bacterial plaque and degree 3 mobility of many teeth.
She was diagnosed with type 1 diabetes mellitus on
FIG. 88.112 Three views show alveolar bone loss and
severe inflammation with spontaneous bleeding, pus
formation, and abscess in a 56-year-old man with type
2 diabetes mellitus who used external insulin for 12

FIG. 88.113 A 28-year-old woman with uncontrolled
type 1 diabetes mellitus was referred with complaints
of rapid mobility of teeth, severe pain, spontaneous
pus, and several abscesses. Her fasting glucose level
was 486 mg/dL on the day of referral. (A) Although the
lesions resembled abscesses of periodontal origin, the
pocket depths and attachment levels were within
normal levels. (B) The computed tomography findings
and consultation with the infection department
confirmed the diagnosis of osteomyelitis. (C) View of
the patient after 1 week of blood glucose control in the
intensive care unit and hyperbaric oxygen therapy. (D)
Although the lesions healed uneventfully, severe
malocclusion was evident at the 1-year follow-up
Aggressive Periodontitis

FIG. 88.114 Three views show aggressive periodontitis
in a 3-year-old boy without systemic diseases. There is
severe alveolar bone destruction of deciduous molar

FIG. 88.115 Two views show extrusion of the left
central incisor in a 21-year-old man with localized
aggressive periodontitis. There is severe breakdown of
alveolar bone of the incisor and mandibular first molar.

FIG. 88.116 Three views show advanced bone loss in
an 18-year-old boy with aggressive periodontitis.

FIG. 88.117 Two views show intrabony defects in a 24-
year-old woman with aggressive periodontitis.

FIG. 88.118 Five clinical and cone-beam computed
tomography views show advanced alveolar bone
resorption around the incisors and first molar in a 24-
year-old man with aggressive periodontitis.

FIG. 88.119 Clinical and radiographic views of a 27-
year-old man show generalized aggressive
periodontitis at (A) the initial visit and (B) the 5-year
follow-up examination after therapy. Cone-beam
computed tomography views show (C, D, and F)
advanced alveolar bone resorption around incisors, (E)
premolars, and (G) first molar.
Periodontitis as a Manifestation of
Systemic Diseases

FIG. 88.120 A 12-year-old girl was referred with
complaints of rapid swelling on (A) the face and (B) the
gingiva, and (C) spontaneous bleeding. The patient
also had persistent fever and general malaise for 2
weeks. (D) Radiographic analysis revealed alveolar
bone loss and separation of the roots of the maxillary
right lateral and canine. Consultation with the
hematology department and histologic analysis of the
lesion confirmed the diagnosis of granulocytic
sarcoma, which can precede acute myelogenous
leukemia. (E) Histologically, infiltration of atypical
myeloid cells into the gingival tissues was evident
(hematoxylin and eosin; original magnification ×100).
(F) The lesion regressed significantly after two courses
of chemotherapy. (From Antmen B, Haytac MC, Sasmaz I, Dogan MC,
Ergin M, Tanyeli A: Granulocytic sarcoma of gingiva: an unusual case with

aleukemic presentation. J Periodontol 74:1514–1519, 2003.)
FIG. 88.121 A 14-year-old boy was referred with
complaints of rapid mobility of teeth, gingival swelling,
persistent fever, and joint pain. (A) Clinical examination

revealed gingival hyperplasia in accordance with the
expansion of jawbones and third-degree mobility in
many teeth despite minimal bacterial plaque. (B) Bone
marrow aspiration biopsy revealed cytoplasmic
vacuolization of lymphoblasts specific for acute
lymphoblastic leukemia type L3 (May-Grünwald
Giemsa stain; original magnification ×100). (C)
Radiographically, there was severe bone loss,
abnormal trabeculation, and radiolucent areas around
roots, which was more prominent on the molar teeth.
(From Haytac MC, Antmen B, Dogan MC, Sasmaz I: Severe alveolar bone loss
and gingival hyperplasia as initial manifestation of Burkitt cell type acute
lymphoblastic leukemia. J Periodontol 74:547–551, 2003.)
FIG. 88.122 Two views show alveolar bone destruction
and gingival enlargement around teeth #41, #42, and
#43 in a 15-year-old boy with acute lymphocytic
Genetic Disorders

FIG. 88.123 A 16-year-old girl who had been receiving
treatment for neutropenia for 8 years was referred for
gingival inflammation. Two views show severe
malocclusion and gingival inflammation, spontaneous
bleeding, deep periodontal pockets up to 15 mm, and
advanced radiographic alveolar bone loss.

FIG. 88.124 An 11-year-old girl with leukocyte
adhesion deficiency was referred to the periodontology
department. She had recurrent skin, ear, upper
respiratory tract, and lung infections since early
childhood and was diagnosed with leukocyte adhesion
deficiency (LAD) 4 years earlier. She had one kidney
surgically removed due to infection. Two views show
severe periodontal breakdown with spontaneous loss
of many teeth and advanced bone loss, deep pockets

up to 15 mm, and mobility for the remaining teeth. The
patient's elder sister, who was 14 years old, also had
LAD and was diagnosed during the same period. The
elder sister's periodontal status is shown in Fig.
FIG. 88.125 Two views show leukocyte adhesion
deficiency in a 14-year-old girl.


FIG. 88.126 Three views show hyperkeratosis of the
palms, loss of anterior teeth, gingival recession, and
extensive radiographic alveolar bone loss of deciduous
teeth in a 3-year-old boy with Papillon-Lefèvre


FIG. 88.127 Three views show effects of Papillon-
Lefèvre syndrome in a 12-year-old girl, including
hyperkeratosis of the palms and soles. The patient had
spontaneous loss of many teeth and deep pockets
ranging from 4 to 12 mm on the remaining teeth.
Severe alveolar bone destruction is seen in the
panoramic radiograph.
FIG. 88.128 Three views show skeletal deformities and
gingival inflammation in a 14-year-old girl with
Necrotizing Periodontal Diseases

FIG. 88.129 Typical punched-out appearance of the
gingiva (arrow) in necrotizing ulcerative gingivitis
(NUG) is seen in a 25-year-old man.
FIG. 88.130 Two views show a necrotizing ulcerative
gingivitis lesion before and after removal of
pseudomembrane in a 27-year-old woman.

FIG. 88.131 Two views show a crater-like lesion and
pseudomembrane formation on the palatal gingiva in a
31-year-old man with necrotizing ulcerative gingivitis.

FIG. 88.132 Three views show severe necrotizing
ulcerative gingivitis (NUG) and a necrotizing ulcerative
periodontitis (NUP) infection that caused extreme pain
in a 22-year-old woman on the first, third, and seventh
day of referral. Rapid soft tissue destruction exposed
the alveolar bone.

FIG. 88.133 Zoledronic acid–related osteonecrosis
occurred in a 54-year-old woman who had been using
the drug intravenously for breast cancer. The lesion
occurred 1 month after extraction of tooth #36.

FIG. 88.134 Three views show rapid gingival and bone
necrosis 1 month (top left), 2 months (top right), and 7
months (bottom) after scaling and root planing in a 52-
year-old woman receiving intravenous zoledronic acid
after breast cancer treatment.
Abscesses of Periodontium

FIG. 88.135 Two views show a periodontal abscess of
the left central incisor in a 21-year-old woman with
aggressive periodontitis.
FIG. 88.136 Periodontal abscess of the maxillary first
molar occurred in a 35-year-old man with chronic

FIG. 88.137 Two views show a periodontal abscess in
a 39-year-old woman before and after treatment.
FIG. 88.138 Pericoronitis is seen around a partially
erupted mandibular third molar in a 19-year-old girl.
Endodontic-Periodontal Lesions

FIG. 88.139 Two views show an endodontic-
periodontal lesion in a 36-year-old man.
FIG. 88.140 Two views show an endodontic-
periodontal lesion in an 18-year-old girl.

Page number followed by f indicates figure, by t table, and by b box.
AAP, American Academy of Periodontology
ABBM, Anorganic bovine bone-derived mineral
Aberrant frenum, problems, 661
Abfraction, 390f, 391
Ablation, 688–689
Abrasions, 390, 390f, 583.e10
Abrasive dentifrice, usage, 514f
classification, 493
clinical photograph, 853f
periodontal origin, e91f
Absolute anchorage, 583.e14
Absorbable gelatin sponge, 601
Absorbable hemostatic agents, 601t
Absorption coefficient, laser, 691f
Abundant keratinized tissue, presence, 615f–616f

color shift in, 780b
design and emergence profile, 779–780, 779f
margins, 779–780, 779f–780f, 780b
material selection, 777–779, 778f, 779b
AC, Acellular cementum
AcceleDent device, 583.e21
Acceleration, orthodontics, 583.e20–583.e21, 583.e20b
stimulatory devices, 583.e20–583.e21
surgical methods for, 583.e20
Accessibility, 545.e1, 545.e1b
Accessory binocular module, 685f
Accessory pulpal canals, presence of, 327
Accessory root canals, prevalence of, 498–499
Accidental damage, 61
Accidental traumatic lesions, e79
Accumulated glycation end-products (AGEs), 211
Acellular afibrillar cementum, 38
Acellular cementum (AC), 38f
arrangement, 38
formation, 38
Acellular extrinsic fiber cementum, composition, 39
Acetaminophen (Tylenol), use of, 505.e4
Achromatic lenses, 684
Acoustic steaming, 546
Acoustic turbulence, 546
Acquired coatings, 27
Acquired deformities/conditions, 56b, e48be49b
Acquired immunodeficiency syndrome (AIDS), 365, 456.e3
acute gingival disease, 491b

advanced, periodontal health (appearance), 372f
HAART, usage, 376
health status, 372–373
infection control measures, 373
maintenance therapy, 373
necrotizing ulcerative periodontitis and, 362, 362b
psychologic factors, 373
therapy, goals, 373
Acquired pellicle, 123
Acrylic provisional fixed full-arch prosthesis, clinical photograph
of, 742f
Actinobacillus actinomycetemcomitans, levels, elevation, 465
Actinomyces odontolyticus (colony morphology), 114f–115f
Actinomyces oris MG1 in vitro, coaggregation, 125f
Actinomyces viscosus
branches, 114f–115f
root surface caries microorganism, 311
Active disease
adjunctive orthodontic therapy, 698
control of, 697–698, 697b
emergency treatment, 697
hopeless teeth extraction, 697
oral hygiene measures, 697
periodontal surgery, 697–698
reevaluation, 697, 698f
resolution, 697f
scaling and root planing (SRP), 697, 697f
Active eruption, 32
Activities of Daily Oral Hygiene (ADOH), index, 476.e2
Acusection, 606
Acute abscess, 496
antibiotic therapy, indications, 496b
chronic abscess, differences, 493
external incision, drainage, 496
periodontal pocket, drainage, 496
tooth elevation, 495f
Acute anginal attacks, nitroglycerin (usage), 444
Acute gingival disease, 271b
acquired immunodeficiency disease (AIDS), 491b
case scenario, 492.e1b, 492.e1f
treatment, 488–492, 491b
Acute gingival infections, 268–276, 276.e1b, 276.e1f
Acute herpetic gingivostomatitis, 275b, 282f, 491
treatment, 492f
Acute inflammation (initiation), neutrophils (impact), 160, 161f
Acute inflammatory enlargement, 257
Acute leukemia
appearance, 635f
periodontal ligament/alveolar bone (involvement), 216, 217f
Acute lymphoblastic leukemia, appearance, 285f
Acute lymphocytic leukemia, e98f
Acute myelocytic leukemia, 215f
anterior view/palatal view of, 217f
Acute myelogenous leukemia
after remission induction chemotherapy, e67f
gingiva/floor, enlargement, e62f
gingival hyperplasia/spontaneous bleeding, e62f
oral cavity, candidal infection, e67f
soft/hard tissue destruction, mucormycosis (impact), e67f
Acute necrotizing ulcerative gingivitis (ANUG), 268
differential diagnosis, reassessment, 491
drugs, role, 490–491

first visit, 488–489
gingiva, contouring, 490
initial therapy, goals, 488b
local therapy, inadequacy, 491
patient instructions, 489
recurrent cases, persistent, 491
second visit, 489–490
systemic disease, 491
third visit, 489–490
treatment, 488, 490f
considerations, 490–491
gingiva, reshaping, 490f
Acute pericoronitis, 492
treatment, 492
Acute phase proteins, 163.e1
Acute respiratory distress, 453.e2
Acute respiratory infections, periodontal disease and, 235.e4
Acute streptococcal gingivostomatitis, lip/gingiva lesions, e65f
Acute trauma, 328–329, 329b, 339
ADA, American Dental Association
Adaptation, 545.e5–545.e6, 545.e5b–545.e6b
Adaptive immunity, 106–109
Addison disease, 252
Additive osseous surgery, 636
impact, 637f
Additive process, of implants, 733.e3, 733.e3f–733.e4f
Adenosine-citrate-dextrose acid (ACD-A) anticoagulant, 665
Adhesion capacity, differences (microscopic confirmation), 118f
Adhesive dentistry, 700f
Adhesive surface proteins, 149

Adipose cells, 28
Adjacent teeth, roots, 706f
Adjunctive therapy, 565f, e8b
combination adjunctive therapy, e29–e30
consideration, e30
idea, data support, e27b
impact, e32
orthodontic, 582–584, 698
SRP, differences, e26
Adrenal crisis, 450.e1, 450.e1b
Adrenal insufficiency, 450.e1–450.e2
Adult blood pressure, classification, 443t
Adult gingiva
appearance, 20f
clinical appearance, 30f
melanotic pigmentation, 30f
Adult oral sedative premedication, usage, 436b
Adult periodontitis, 283
Adult sedation, 432–434
Advanced alveolar bone resorption, clinical/cone-beam computed
tomography, e95f
Advanced bone loss, 655f, 854f
aggressive periodontitis, presence, e93f
bacterial plaque, impact, e89f
presence of, mesial root resection, 658.e6f
resection of, 658.e1f
Advanced chronic periodontitis, e51f
hygiene neglect/smoking, contributing factors, e86f
Advanced gingivitis, 247f
Advanced glycation end products (AGEs), 350

Advanced horizontal bone loss, 583.e3–583.e4
Advanced lesion, 93–94, 93f
Advanced periodontitis, pocket wall (bacterial penetration), 118f
Advanced radiographic alveolar bone, observation, e99f
Aegina, Paul, ei
Aerosol production, 549, 549b
Aesthetic tissue management, 702–703
Aesthetic zone, 702, 663.e18
implant placement, 857
Aesthetics, 583.e7
augmentation surgery, 819b, 818.e1
complications, 846, 856–857, 857b, 857f
diffuse melanin pigmentation, e51f
examination, components, 820
final outcome, 818.e1
outcome from intraoral and extraoral, 711f
predictable, surgical strategy for, 818
gingival recession, 854f
melanin pigmentation, e51f
results, 871–872
success, 872
surgical aesthetic goal, level of, 818f, 818.e1, 818.e1f
tissue preservation in, 818.e1
After Five curette, 536–537, 537f
Gracey curette, comparison, 537f
Mini Five curette, comparison, 537f
Afunctional atrophy, 47
Agammaglobulinemia, presence of, 214f, 218.e2
Agar plates, periodontal/cariogenic species, 114f–115f
AGEs, Accumulated glycation end-products

Aggregatibacter actinomycetemcomitans, 71, 195, 445
colonization, 353
complement evasion, 150
counts, 184–186
etiologic agent, 410–411
growth, 114f–115f
inhibition, tetracyclines (usage), 557
involvement, 283
isolates, 131–132
LtxA production, 149
prevalence, 363
primary etiologic agent, 146–147
role, decrease, 52
strain JP2, 358
translocation, 132
Aggressive periodontitis, 56b, 65–68, 147, 283, 352–360, 479–487,
e48be49b, e92
advanced bone loss, e93f
alveolar bone destruction, 322, 325b
anterior dentition (image), 558f
antibiotic therapy, 485t
antiinfective therapy, considerations, 359
antimicrobial therapy, 480–486
appearance, 284f
bacterial challenge, host response, 358–359
case definition, 355–356
case scenario, 487.e2f, 360.e1b–360.e2b, 360.e1f–360.e2f, 487.e2b
chronic periodontitis, differences, 65–68
classification, 352–355
clinical characteristics, 352–355
cyclic neutropenia and agammaglobulinemia, presence of, 214f
dental implants, usage, 486–487, 487b
diagnostic criteria, 353t
epidemiology, 355–358

features, 352–353
full-mouth disinfection, 486
full-mouth radiographs, 482f–483f
generalized form, 65–68, 283
family studies, 359
polymorphisms, 359
GLT6D1, association, 177
host modulation, 486
host response, 358–359
implant therapy, 360
independent gene association reports for, 176t
intraoral clinical photographs, 482f–483f
local delivery, 486
localized aggressive periodontitis, 146–147
localized form, 68b
microbial testing, 485–486
microbiology, 358
oral rehabilitation, 360
panoramic image, 557f
pathobiology, 358–359
periodontal maintenance, 487
periodontal therapy, 480
postoperative radiographs, 485f, 558f
preoperative radiograph (anterior mandible), 558f
prevalence, assessment, 355–356
probing depths, 69f
prognosis, 479, 480b
regenerative therapy, 480
risk factors, 358–359
subgroups, 353–355
supportive periodontal therapy, 359–360
surgical resective therapy, 480
surgical therapy, 359
susceptibility, environmental factors, 359
systemic diseases, absence, e92f
therapeutic considerations, 359–360, 359b
therapeutic modalities, 479–486
treatment, 479–487
planning/restorative considerations, 486–487
systemic tetracycline, usage, 485b
understanding, 358
Aging, biological effects, 54b
Agranulocytosis, 213–214, 453
characterization, 271
AHA, American Heart Association
AI-2 (strain-specific competence-stimulating peptides)
functions, 130
production/detection, 130
AIDS, Acquired immunodeficiency syndrome
Air-powder polishing, 544–545, 544f
Airway status, 461f
Albright syndrome, Polyostotic fibrous dysplasia
Albucasis, ei
Albucasis periodontal instruments, eiif
Alcohol abuse
CAGE test, 478.e1f
diagnosis, 478.e1
Alcohol consumption, 476.e3
Alcoholism, 478.e1
Alendronate (Fosamax), 221t
Alertness/sedation scale, observer assessment, 439t
Allele, 168t–169t
Allergies, e78, e78f
outpatient surgery, 602

Allogenic bone graft, usage, 74f
Allogenic bone-grafting materials, 651.e2
Allogenic succession, 140
Allografts, 645, 651.e2t
Alloplastic bone-grafting materials, 651.e2
Alloplasts, 651.e2t
Al-Tasrif, ei
Altered passive eruption, 663.e20
Alveolar bone, 47
aging, impact, 52
cancellous portion, 43–44
CEJ (relationship), periapical radiographs (usage), 397–398
destruction, e98f
aggressive periodontitis, 322
mucormycosis infection, impact, e68f
panoramic radiograph, e103f
development, 47
loss, panoramic radiograph of, 592f
vertical increase, 813
involvement of, 216
leukemic infiltrate, 216f
loss, 390.e1
appearance, e86f
external insulin and, e90f
metabolism, periodontal ligament (impact), 52
morphologic changes, 52
morphology, 637
remodeling, 45–46
resorption, 101–102
stimulation, slightly excessive pressure, 330
space, requirement, 746b
variation in, 321
vertical bitewing films, usage, 399f

Alveolar crest
apical position, 312–313
coronal radiation, 34f
oblique extension, 34
Alveolar dimension, 748f
Alveolar mucosa (AM), 31f
Alveolar process, 41–46, 591
components, 41
divisibility, 41
knife-edge alveolar process, 788
remodeling, 43
sockets in, 592
Alveolar ridge
construction, 698.e2, 698.e5f–698.e6f
defect, 76f
evaluation, 764, 764f–765f
extractions, management of, 802–803
delayed implant placement for, 802–803
immediate implant placement for, 803, 804f
staged implant placement, 803
loss, 591f
clinical image, 74f
preservation, 698.e1, 698.e2f
Amalgam, 196f
retrofill, impact, 62f
Ameloblastic epithelium, reduction, 27
Ameloblastoma, appearance, e84f
American Academy of Oral and Maxillofacial Radiology,
recommendation, 766b
American Academy of Pediatric Dentistry, 5t
American Academy of Periodontology (AAP), 5t, evii

American Dental Association (ADA), 5t
conscious sedation policy statement/guidelines, 431–432
Council on Scientific Affairs, 520.e2–520.e3
sedation usage/general anesthesia, 432
guidelines, 432
American Heart Association (AHA), 5t
American Society of Anesthesiologists Physical Status Classification
System, 434t
Amine fluoride, 529
Amino groups, 194
Aminobisphosphonate medications, therapeutic uses, 221t
ε-aminocaproic acid (Amicar), 452
Amlodipine-associated gingival enlargement, e64f
Amniotic fluid levels, in experimental periodontitis, 235.e2f
Amoxicillin, 485b, 560
use of, 505.e4
Amoxicillin-clavulanate potassium, 560, 487.e1
Anamnesis, 524
Anatomic area, schematic diagram, 755f
Anatomic crown/root, distinction, 32
Anatomic factors, 419
impact, 411
Anatomic location, 869
Anatomic spaces, 595–598
Anatomic structures, identification, 753b, 762, 762b
Anchor suture, 614.e2
Anchorage, 583.e14–583.e15
direct, 583.e14f–583.e15f, 583.e19
indirect, 583.e15f–583.e16f, 583.e19

Anemia, e62fe63f, 218.e1, 218.e1f, e62
Anesthesia, 600
discovery of, eiii–eiv
Anginal episode, 444–445
Angiogranuloma, 263
Angioplasty, 445
Angiotensin-converting enzyme (ACE) inhibitors, 445
Angular bone loss
existence, 641
furcation, involvement, 400f
mandibular molar location, 400f
Angular cheilitis, 220.e1
severe, 367.e2f
Angular defects (bone), 322–325
Angulation, 545.e6–545.e7, 545.e6b
Aniacinosis, 220.e1
Animals, mitotic rate, 27.e1
Ankyloblepharon, 294
Ankylosis, 41
results, 41.e1
Anorganic bovine bone-derived mineral (ABBM), 808
Anosmia, 524.e1–524.e2
Anoxemia, 245
ANRIL, 351
Anterior aesthetic surgery, 704.e2, 704.e2f–704.e3f
Anterior gingival tissues, initial view, 489f
Anterior open-bite, malocclusion, e54f
Anterior-posterior (A-P) implant spread, 783.e1, 783.e1f

Anterior sector, moderate-to-severe periodontitis in, 588–589
Anterior teeth
loss, e102f
mobility, 457–458
agents, 559
bacteriostatic versus bactericidal, 556b
prophylaxis regimens, 446t
resistance, 487.e1
selection (decision tree), 562f
serial/combination antibiotic therapy, 561–563
systemic administration, 556–561
background/rationale, 556–557
tetracyclines, 557–559
usage, 556t, 505.e2–505.e3
guidelines, 561–563
Antibodies, 109
Antibody deficiency disorders, 218.e2
Anticoagulant, 454
medications, 452, 453b
Anticonvulsants, 260
Anticytokine drugs, development, 573.e1
Antigen-presenting cells, 106
Anti-infective agent
chemotherapeutic agent, 556
definitions, 556
Antiinflammatory cytokines, 100
Antiinflammatory mediators, 565.e2
Antimicrobial agents, delivery, drawbacks, e11
Antimicrobial peptides, 157–158
in periodontitis, 158, 158b

Antimicrobial resistance, biofilm (relationship), 131, 131b
Antiplaque agents, usage, 477–478
Antiplatelet medications, 452–454
Antiretroviral therapy, 365.e4–365.e5, 365.e5b
ANUG, Acute necrotizing ulcerative gingivitis
Anxiolysis, minimal sedation and, 439.e1–439.e4
Aortocoronary bypass (cardiac bypass), 445
Aphthous lesions, recurrent, e78f
Aphthous ulcers, recurrent, e66f
Apical abscesses, drainage from, 505.e3
Apical diseases
classification of, 501–502
initiation of, factors of, 500–501
Apical fibers, 34
Apical vessels, branches, 48
Apically displaced flap, 620–621, 631, 663.e6, 663.e8f
facial/lingual preoperative views, 620f
selection, 620
Apicoectomy, impact, 62f
Aplastic anemia, 218.e1
appearance, 281f
Apneic episode, 458, 463.e2b
Arachidonic acid (AA), 160
Arbitrarily primed-polymerase chain reaction, 131–132
Arbitrary values, 87
Archaea, 137
Archetypal proinflammatory cytokine, 105
Area-specific curettes, 534–539, 545.e8–545.e9, 545.e27f

curved blade, presence, 535–536
universal curettes, comparison, 536t
Arg-gingipains, 149
Arginyl-glycyl-aspartic acid sequences, 39.e1
Argon laser, 689t
Ariboflavinosis, 220.e1
Arterial blood supply, importance of, 594, 594f
Arterial oxygen tension, tissue oxygenation, 439, 439t
Arterioles, 29
diagram, 29f
Articulated diagnostic casts, 579
Artzney Buchlein, eii
Aspergillosis, 137t
Aspirin, 161, 452
Aspirin triggered lipoxins (ATLs), 161
Aspirin-induced chemical burn, 205f
analysis, 171–172, 172f
spurious associations, schematic representation, 16f
study, example, 166.e1t–166.e199t
Assyrian clay tablets, evi
Asthma, periodontal disease and, 235
Atherosclerosis, 231
coronary angiogram, 444f
pathogenesis of, 231b, 231f
periodontal disease and, 228–233
periodontal infection and, 232f, 233b
Atherton tissue, 583.e18
ATLs, Aspirin triggered lipoxins

Atopic dermatitis, pruritic lesions, e75f
Atraumatic microsurgical tissue manipulation, 681f
Atrophic lesions, 291
Atrophic lichen planus, impact, e72f
Atrophic periodontal ligament, 48f
Atrophy, 32
afunctional atrophy, 47
disuse atrophy, 47
Attached gingiva, 20, 386f, 389–390, 587–588
appearance, 279f
demarcation, 30
fistula, maxillary right first molar, 495f
impact, 21f
interdental papillae, 21f
mean width, 20f
problems, 660–661
stippling, 31
techniques, increase, 663.e1–663.e17
variation, 277
width, 20
Attached plaque, 311
apparatus, development, 46–47
level, 389, 389f, 390.e3f
loss, 312f, 389
bone loss, relationship, 312
pattern of, 655
prevention of, 724–725, 725f–726f
treatment of, 725–726, 725f, 726b
Attributable risk, 172
percentage, 86–87
Attrition, 390

Atypical ulcers (nonspecific oral ulcerations), 369
convex ridge shape after, 708f
maxillary sinus, 813b
surgery, bone and soft tissue overbuilding, 819b, 818.e1
Augmented reality, 842–844
Autogenic succession, 140
Autogenous bone, 808, 794.e3–794.e4
Autogenous bone grafts, 645–646
complications related to, 856.e1
Autogenous bone harvesting, complications related to, 856.e1
Autogenous monocortical block graft, harvesting, 797, 795.e2f
Autografts, 645
iliac autograft, 646.e2f
Autoinducer 2, 130
Autologous fibrin sealers, 664
Autologous platelet concentration, 815.e1–815.e2
Autologous PRP, use of, 647
Automatic cardioverter-defibrillators, 442
Automatic periodontal probing, 388.e1
Autosomal dominant inheritance pattern, 168t–169t
Autosomal recessive inheritance pattern, 168t–169t
Autosome, 168t–169t
Avascular necrosis, 221
Avicenna, ei
Avulsed teeth, replantation, 3f
Axis II mental disorders, 339b
Azithromycin, 487.e1
administration, 629
Bacillary (epithelioid) angiomatosis (BA), 368
Bacilli, eii–iii
Back-action chisel, 607f
Background characteristics, 411–412
Bacteria, reservoir for, subgingival environment as, 228
Bacteria-host interactions (modulation), oral streptococci (impact),
Bacterial accumulation areas, 308
Bacterial biofilms, 505.e2
Bacterial challenge
host response, 358–359
schematic illustration of, 109, 110f
Bacterial deoxyribonucleic acid (DNA), 95–96
Bacterial endocarditis, 445
Bacterial endotoxin, 310b
Bacterial enzymes, 94
impact, 130
Bacterial pathogens, 210–211
identification, 139–140
Bacterial plaque, 52–53, eiv
impact of, 653
periodontitis and, 90
Bacterial resistance, development (risk), 556–557
Bacterial species, summary, 144t–145t
Bacterial transmission/translocation, 131–133
Bacterial vaginosis, 235.e1–235.e2
adherence, ability, 113
biofilm mode of living, 117–129
identification, molecular methods, 138
initial adhesions/attachment, 124
pathogenic bacteria, 142, 142t
scanning electron micrograph, 123f
survival, strategies, 116
Bacteroides gingivalis, 80
Bacteroides intermedius, 465
Bad breath
cause of, 524b
diagnosis of, terms for, 521b, 527b
hormonal causes of, 523.e1
metabolic disorders and, 523.e1
Baking soda, 529
Ball sickle scaler, 533, 606–607
BANA test, 528.e1
Bard-Parker knife, usage, 615
Barrier membranes, 794.e2–794.e3
nonresorbable, 794.e2–794.e3
resorbable, 794.e3
Bartholin duct, e55f
Basal cell layer, 24f
Basal lamina, 24
fibrils, connection, 24
internal basal lamina, 25
Basement membrane, immunofluorescent-labeled antibodies, 60f
Basic life support (BSL), impact, 435–436
Bass method, 515f, 516b

Bass technique, 515–516
B-complex deficiency, 220.e1–220.e2
Behavioral considerations, 751
Behavioral Risk Factor Surveillance System (BRFSS), 476.e6
Behçet disease, e78f
Beneficial species, 143
Benign mucous membrane pemphigoid, 60f
Benign paroxysmal positional vertigo (BPPV), crestal sinus lift and,
Benzene intoxication, 224.e3
intravenous administration of, 600.e1
intravenous sedation, single, 439.e5–439.e6
Benzothiazepine derivatives, 260
Beriberi, 220.e1
Berlin group, ev–evi
Beta-adrenergic receptor antagonists (β-blockers), usage, 443–444
types, 444t
Bevel incision, diagram, 610f
Bile pigments, 252
Bioactive glass, 647.e1
Biofilm, 112–150, 126b
accumulation, 122–126
antimicrobial resistance, relationship, 131
characteristics, 129–131
communication, 130
case scenario, 150.e1b–150.e3b
control, 417–418
checking of, 716–719
evaluation, 862

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C H A P T E R 8 8Atlas of PeriodontalDiseasesM. Cenk Haytac, Onur Ucak TurerCHAPTER OUTLINEPlaque-Induced Gingival DiseasesCauses of Periodontal DiseasesGingival Diseases Modified by Systemic FactorsGingival Diseases Associated With Blood DyscrasiasDrug-Induced Gingival DiseasesNon–Plaque-Induced Gingival LesionsGingival Lesions of Genetic OriginGingival Manifestations of Systemic ConditionsTraumatic Lesions: Factitious, Iatrogenic, and AccidentalCysts and TumorsChronic PeriodontitisAggressive PeriodontitisPeriodontitis as a Manifestation of Systemic DiseasesGenetic DisordersNecrotizing Periodontal Diseases4646 Abscesses of PeriodontiumThis chapter provides additional illustrations for Chapter 27 andthe chapters in Part 2 and in Sections 1 and 2 of Part 3. Thepresentation of cases follows the classification of periodontaldiseases and conditions developed by the 1999 InternationalWorkshop for the Classification of Periodontal Diseases, which wasorganized by the American Academy of Periodontology (seeChapter 4). All illustrations are from the Archives of theDepartment of Periodontology, School of Dentistry, CukurovaUniversity, Adana, Turkey (Box 88.1). Box 88.1Gingival DiseasesPlaque-Induced Gingival DiseasesI. Gingivitis associated with dental plaque onlyA. Without local contributing factorsB. With local contributing factors (see Figs. 88.1 to 88.32)II. Gingival diseases modified by systemic factorsA. Associated with endocrine system1. Puberty-associated gingivitis (see Fig.88.33)2. Menstrual cycle–associated gingivitis (seeFig. 88.34)3. Pregnancy-associated gingivitis (see Figs.88.35 to 88.37)a. Gingivitisb. Pyogenic granuloma4. Diabetes mellitus–associated gingivitisB. Associated with blood dyscrasias1. Leukemia-associated gingivitis (see Figs.88.38 to 88.40)4647 2. Other (see Figs. 88.41 to 88.46)III. Gingival diseases modified by medicationsA. Drug-induced gingival diseases1. Drug-influenced gingival enlargement (seeFigs. 88.47 to 88.51)2. Drug-influenced gingivitisa. Oral contraceptive–associatedgingivitisb. OtherIV. Gingival diseases modified by malnutritionA. Ascorbic acid–deficiency gingivitisB. OtherNon–Plaque-Induced Gingival LesionsI. Gingival diseases of specific bacterial originA. Neisseria gonorrhoeaeB. Treponema pallidumC. Streptococcus species (see Fig. 88.52)D. OtherII. Gingival diseases of viral originA. Herpesvirus infection (see Fig. 88.53)1. Primary herpetic gingivostomatitis2. Recurrent oral herpesvirus infection3. Varicella zosterB. Other (see Fig. 88.54)III. Gingival diseases of fungal originA. Candida species infections: generalized gingivalcandidiasis (see Figs. 88.55 and 88.56)B. Linear gingival erythemaC. HistoplasmosisD. Other (see Figs. 88.57 and 88.58)IV. Gingival lesions of genetic originA. Hereditary gingival fibromatosis (see Figs. 88.59 to88.61)B. OtherV. Gingival manifestations of systemic conditions4648 A. Mucocutaneous lesions1. Lichen planus (see Figs. 88.62 to 88.65)2. Pemphigoid3. Pemphigus vulgaris (see Fig. 88.66)4. Erythema multiforme5. Lupus erythematosus6. Drug induced7. Other (see Figs. 88.67 to 88.73)B. Allergic reactions1. Dental restorative materialsa. Mercuryb. Nickelc. Acrylicd. Other2. Reactions attributable to the followinga. Toothpastes or dentifricesb. Mouthrinses or mouthwashesc. Chewing gum additivesd. Foods and additives (see Fig.88.74)3. OtherVI. Traumatic lesions: factitious, iatrogenic, or accidental (seeFigs. 88.75 to 88.92)A. Chemical injuryB. Physical injuryC. Thermal injuryVII. Foreign body reactionsVIII. Not otherwise specifiedA. Cysts and tumors (see Figs. 88.93 to 88.102)Chronic Periodontitis (see Figs. 88.103 to 88.108)I. LocalizedII. GeneralizedIII. Chronic periodontitis modified by systemic disordersA. Diabetes mellitus (see Figs. 88.109 to 88.113)4649 Aggressive Periodontitis (see Figs. 88.114 to 88.119)I. LocalizedII. GeneralizedPeriodontitis as a Manifestation of Systemic DiseasesI. Hematologic disordersA. Acquired neutropeniaB. Leukemias (see Figs. 88.120 to 88.122)C. OtherII. Genetic disordersA. Familial and cyclic neutropenia (see Fig. 88.123)B. Down syndromeC. Leukocyte adhesion deficiency syndromes (see Figs.88.124 and 88.125)D. Papillon-Lefèvre syndrome (see Figs. 88.126 and88.127)E. Chediak-Higashi syndromeF. Histiocytosis syndromesG. Glycogen storage diseaseH. Infantile genetic agranulocytosisI. Cohen syndromeJ. Ehlers-Danlos syndrome (types 4 and 8)K. Hypophosphatasia (see Fig. 88.128)L. OtherIII. Not otherwise specifiedNecrotizing Periodontal DiseasesI. Necrotizing ulcerative gingivitis (NUG) (see Figs. 88.129 to88.131)II. Necrotizing ulcerative periodontitis (NUP) (see Fig. 88.132)III. Bisphosphonate-related osteonecrosis (see Figs. 88.133 and88.134)Abscesses of the Periodontium4650 I. Gingival abscessII. Periodontal abscess (see Figs. 88.135 to 88.137)III. Pericoronal abscess (see Fig. 88.138)Periodontitis Associated With Endodontic LesionsI. Endodontic-periodontal lesions (see Figs. 88.139 and 88.140)II. Periodontal-endodontic lesionsIII. Combined lesionsDevelopmental or Acquired Deformities and ConditionsI. Localized tooth-related factorsII. Mucogingival deformities around teethIII. Mucogingival deformities on edentulous ridgesIV. Occlusal traumaPlaque-Induced Gingival DiseasesClinical Features of GingivitisBleedingColor ChangesConsistencySurface TexturePositionContour4651 FIG. 88.1 In the healthy gingiva of a 17-year-old girl,notice the demarcation (mucogingival line) (arrows)between the attached gingiva and the darker alveolarmucosa.FIG. 88.2 Two views show prominent stippling ofhealthy gingiva in a 21-year-old man.4652 FIG. 88.3 Bright-red color and loss of stippling of thegingiva is seen in a 21-year-old woman with gingivitis.FIG. 88.4 Two views show bleeding on probing in a24-year-old man with gingivitis and inflammatoryenlargement.4653 FIG. 88.5 Plaque accumulation and red color of thegingiva are seen in a 17-year-old girl with gingivitis.FIG. 88.6 Bluish red color of the gingiva is seen in a46-year-old man with advanced chronic periodontitis.Melanin Pigmentation4654 FIG. 88.7 Two views show melanin pigmentation thatcaused aesthetic problems in a 21-year-old womanand the gums 6 months after treatment with a carbondioxide laser.FIG. 88.8 Two views show diffuse melaninpigmentation that caused aesthetic problems for a 34-year-old woman and the gums 2 months aftertreatment with conventional gingivectomy.4655 FIG. 88.9 Two views show localized melaninpigmentation in a 26-year-old woman and the result 1month after treatment with a carbon dioxide laser.4656 FIG. 88.10 Two views show diffuse localized melaninpigmentation in a 33-year-old woman and the result 1month after carbon dioxide laser treatment.Causes of Periodontal DiseasesMicrobial Dental PlaqueCalculusOne-Sided ChewingMalocclusion4657 Mouth BreathingFIG. 88.11 Severe plaque accumulation and gingivitisoccurred in a 13-year-old boy with neglected hygiene.FIG. 88.12 Extensive plaque formed in a 46-year-oldman with chronic periodontitis. Darker shades ofgingiva are seen in areas with subgingival calculus.4658 FIG. 88.13 Three views show extreme plaqueformation and periodontitis in a 52-year-old womanwith prolonged neglect of oral hygiene procedures.FIG. 88.14 Plaque formation was caused by habitual4659 one-sided chewing in a 9-year-old boy. The patient hadavoided chewing on the right side because of themobility of deciduous teeth.FIG. 88.15 There is extensive plaque accumulationand severe inflammation in a 35-year-old male smoker.FIG. 88.16 Advanced plaque and calculus formedaround implants in a 72-year-old woman.4660 FIG. 88.17 Plaque and calculus formed aroundimplants in a 55-year-old man.FIG. 88.18 Three views show calculus formation onteeth #26 and #27 where the parotid gland duct (i.e.,Stensen duct) opens in a 47-year-old man. Theseteeth had lost their functional antagonists. Calculusalso covered the occlusal surfaces.4661 FIG. 88.19 Calculus formed on upper molars adjacentto the Stensen duct in a 44-year-old man. Notice thedivergence of the roots of the first molar.FIG. 88.20 Anterior open-bite malocclusion and theloss of functional antagonist teeth caused extensivecalculus formation on the left maxillary teeth in this 35-year-old woman.4662 FIG. 88.21 Bridge-like formations of calculus resultedfrom malocclusion, loss of an antagonist tooth, tilting ofthe remaining teeth, and avoidance of chewing on theaffected site in a 49-year-old woman.FIG. 88.22 Two views show extensive calculus thatformed adjacent to the Stensen duct in a 53-year-oldman.4663 FIG. 88.23 Extensive bridge-like calculus formed onthe lingual surfaces of the lower anterior teeth wherethe Wharton and Bartholin ducts empty in a 36-year-old man.4664 FIG. 88.24 (A) Extensive bridge-like calculus formedon the lingual surfaces of the lower anterior teethwhere the Wharton and Bartholin ducts empty in a 42-year-old woman. (B) In the same patient seen in Aafter extraction of the left central incisor, calculus hascovered almost all surfaces of the tooth.FIG. 88.25 A radiograph shows the radiopaqueprojection of extensive calculus, which is comparedwith its appearance after extraction in a 62-year-old4665 man.FIG. 88.26 Three views show the extreme plaque andcalculus formation that was caused by habitual one-sided chewing in a 35-year-old woman. The patienthad avoided chewing on the left side for 10 years.4666 FIG. 88.27 Extensive plaque and calculus formationwas associated with crowding of the teeth in a 21-year-old woman.FIG. 88.28 Periodontal destruction was associated withclass III malocclusion in a 35-year-old man.4667 FIG. 88.29 Four views show extensive calculusformation in a 9-year-old child with an open bite andlack of hygiene.4668 FIG. 88.30 Two views show plaque formation andgingival inflammation with crowding andsupernumerary teeth in a 14-year-old boy.FIG. 88.31 Gingival inflammation and enlargement was4669 associated with chronic habitual mouth breathing in a16-year-old boy. There is clear demarcation of theaffected gingiva.FIG. 88.32 Two views show extensive plaque andcalculus formation in a 27-year-old woman and thesame patient after 2 months of receiving initialdebridement and oral hygiene instruction. Although thepatient still has hygiene problems, the inflammation,redness, and contour of the gingiva are greatlyreduced.Gingival Diseases Modified bySystemic Factors4670 Endocrine SystemSex HormonesFIG. 88.33 Puberty gingivitis in a 14-year-old girl wasassociated with poor hygiene, crowding of teeth, andmouth breathing. Gingival hyperplasia was confined tothe anterior regions.FIG. 88.34 Periodic localized color changes of thegingiva around maxillary anterior teeth wereassociated with menstruation in a 29-year-old woman.4671 FIG. 88.35 Localized gingival enlargement occurred ina 24-year-old woman who was in the seventh month ofpregnancy. The lesion was first noticed in the fourthmonth by the patient.FIG. 88.36 Severe gingival enlargement occurred in a29-year-old woman who was 8 months pregnant.4672 FIG. 88.37 Gingival enlargement in a 32-year-oldwoman in the (A) seventh, (B) eighth, and (C) ninthmonths of pregnancy and (D) at 1 month after delivery.Notice the progression of the dimensions and theincrease of the vascularization of the lesion. (E) Theextraoral view shows the lesion interfering withocclusion and aesthetics.Gingival Diseases Associated WithBlood DyscrasiasLeukemia4673 FIG. 88.38 Two views show gingival hyperplasia andspontaneous bleeding (left) in a 6-year-old boy withnewly diagnosed acute myelogenous leukemia andafter one course of chemotherapy and periodontaltreatment (right).FIG. 88.39 Enlargement of the gingiva and floor of themouth occurred in an 8-year-old boy with acutemyelogenous leukemia.4674 FIG. 88.40 Severe gingival inflammation, hyperplasia,and the results of poor hygiene are seen in a 46-year-old man with chronic myelogenous leukemia.AnemiaFIG. 88.41 Pale gingiva and apparent vascularstructures are seen in a 22-year-old woman with irondeficiency anemia.4675 FIG. 88.42 Severe malocclusion and gingival recessionoccurred in an 18-year-old boy with thalassemia.FIG. 88.43 Skeletal disturbance of the thumb (left) andsevere gingival inflammation with spontaneousbleeding (right) occurred in a 12-year-old boy withFanconi anemia.4676 FIG. 88.44 Localized bleeding occurred in the tissue ina 24-year-old woman with Glanzmann thrombasthenia.FIG. 88.45 Plaque accumulation and spontaneousbleeding occurred in a 28-year-old patient withhemophilia A who neglected oral hygiene proceduresdue to severe bleeding.4677 FIG. 88.46 Spontaneous bleeding and clot formationoccurred in a 22-year-old man with von Willebranddisease.Drug-Induced Gingival DiseasesFIG. 88.47 Gingival enlargement was associated withphenytoin use in a 20-year-old patient with epilepsy.4678 FIG. 88.48 Amlodipine-associated gingivalenlargement was seen in a 47-year-old man withhypertension.FIG. 88.49 Gingival enlargement occurred in a 44-year-old man receiving cyclosporine after kidneytransplantation.4679 FIG. 88.50 (A) In a case of cyclosporine-associatedgingival enlargement, the clinical crowns are coveredand enlargement reaches up to the occlusal plane. (B)Intraoperative view of the enlargement. Views of thepatient after (C) 6 and (D) 12 months. (From Haytac CM, UstunY, Essen E, Ozcelik O: Combined treatment approach of gingivectomy and CO2laser for cyclosporine-induced gingival overgrowth. Quintessence Int 38(1):e54-e59, 2007.)4680 FIG. 88.51 Gingival thickening and hyperplasiaoccurred in a 25-year-old male bodybuilder who hadbeen using steroid injections for 3 years.Non–Plaque-Induced Gingival LesionsStreptococcus Species InfectionsFIG. 88.52 Lesions on the lip and gingiva are seen in a7-year-old child with acute streptococcalgingivostomatitis.4681 Herpesvirus InfectionsFIG. 88.53 Ruptured and unruptured herpetic vesicles(arrows) are seen in a 19-year-old male with herpeticgingivostomatitis.FIG. 88.54 Two views show recurrent aphthous ulcersin a 27-year-old woman.Gingival Diseases of Fungal Origin4682 FIG. 88.55 Four views show severe mucositis on thegingiva, cheek, palatal mucosa, and tongue of a 7-year-old boy with acute myelogenous leukemia afterremission induction chemotherapy. These lesions arevery prone to candidal infections.4683 FIG. 88.56 Candidal infection of the oral cavityoccurred after chemotherapy in a 3-year-old boy withacute myelogenous leukemia.FIG. 88.57 Mucormycosis caused soft and hard tissuedestruction in a 9-year-old patient with acutemyelogenous leukemia.4684 FIG. 88.58 (A) Two views show rapid gingival andalveolar bone destruction caused by mucormycosisinfection in a 14-year-old boy with acute myelogenousleukemia. The lesions started on the third day ofchemotherapy, and breakdown occurred within 1week. (B) Histologic analysis used Gomorimethenamine silver staining, which showed fungalhyphae. (Courtesy Dr. M. Cem Dogan and Dr. M. Cenk Haytac.)Gingival Lesions of Genetic OriginHereditary Gingival Fibromatosis4685 FIG. 88.59 Hereditary gingival fibromatosis occurred ina family. Intraoral views of the father were obtained in(A) 2000, (B) 2003, and (C) 2005.4686 FIG. 88.60 Hereditary gingival fibromatosis occurred ina family. In four views of the father in 2000, notice thesevere enlargement of the tuberosities contacting themandibular ridges and the root fragments in theovergrown tissue.4687 FIG. 88.61 Hereditary gingival fibromatosis occurred ina family. Intraoral views of the younger son show hiscondition when he was (A) 10 days and (B) 2 yearsold. (From Haytac MC, Ozcelik O: The phenotypic overlap of syndromesassociated with hereditary gingival fibromatosis: follow-up of a family for five years.Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 103:521–527, 2007.)Gingival Manifestations of SystemicConditionsMucocutaneous Lesions4688 FIG. 88.62 Severe desquamation and positive Nikolskysign were seen in a 56-year-old woman with lichenplanus. Desquamation leaves the connective tissueexposed and painful in response to stimulant agents.4689 FIG. 88.63 Two views show reticular lichen planus in a63-year-old woman who was referred because of acomplaint of a burning sensation in her mouth.4690 FIG. 88.64 Two views show desquamation andspontaneous bleeding in a 62-year-old woman witherosive lichen planus. The patient was extremelysensitive to temperature changes and foods.4691 FIG. 88.65 Two views show atrophic lichen planus thatexposed connective tissue in a 62-year-old man.4692 FIG. 88.66 Three views show pemphigus vulgarischaracterized by desquamation, pain, and bleeding ina 56-year-old woman. The suprabasal andsubepithelial separation of cells can be detected in thehistologic analysis.Other Systemic Diseases4693 FIG. 88.67 Four views show developmental deformitiesof the fingers and limited mouth opening in an 18-year-old boy with scleroderma. Insufficient attached gingivalwidth complicates oral hygiene procedures, andadvanced gingival recession is seen on the lowercentral incisor.FIG. 88.68 Gingival enlargement occurred in a 9-year-old boy with juvenile hyaline fibromatosis.4694 FIG. 88.69 Four views show atopic dermatitischaracterized by pruritic lesions on the extremities andlips of a 22-year-old woman. Notice the inadequatevestibular depth and gingival recession.4695 FIG. 88.70 Five views show fibrous dysplasiacharacterized by unilateral fibroosseous expansion ofthe bones in a 17-year-old girl. Notice the facialasymmetry, advanced malocclusion, migration of teethstarting from the midline, and gingival enlargement inaccordance with expansion of the underlying bones.The radiograph shows unilateral increases of thedimensions of mandible and maxilla.4696 FIG. 88.71 Three views show Sturge-Weber syndromecharacterized by unilateral cavernous hemangiomason the face and neck of a 35-year-old man. Notice theunilateral soft tissue and easily bleeding gingivalenlargement with high vascularization on the affectedsite.4697 FIG. 88.72 Three views show Rothmund-Thomsonsyndrome characterized by photosensitivity andhypopigmentation and hyperpigmentation on the skinof a 16-year-old girl. Notice the decreasedkeratinization and spontaneous bleeding of the gingiva.Histologic analysis showed discontinuity of thebasement membrane. (From Haytac MC, Oztunç H, Mete UO, Kaya M:Rothmund-Thomson syndrome: a case report. Oral Surg Oral Med Oral PatholOral Radiol Endodontol 94:479–484, 2002.)4698 FIG. 88.73 Four views show recurrent major aphthouslesions on the cheek and lip mucosa, tongue, andalveolar mucosa in a 42-year-old man with Behçetdisease.Allergies4699 FIG. 88.74 Four views show results of the oralchallenge test for the diagnosis of an allergic reactionof the gingiva to apples in a 48-year-old woman. Noticethe formation of blisters, desquamation, andsubepithelial bleeding. (From Haytac MC, Ozcelik O: Oral challengetest for the diagnosis of gingival hypersensitivity to apple: a case report. Oral SurgOral Med Oral Pathol Oral Radiol Endodontol 101:317–321, 2006.)Traumatic Lesions: Factitious,Iatrogenic, and AccidentalFIG. 88.75 Inadequate margins, design, and shape ofthe restoration violating the biologic width causedsevere gingival inflammation in a 32-year-old woman.4700 FIG. 88.76 Overhanging margins and injury werecaused by the self-curing acrylic used for restoration ina 49-year-old woman.4701 FIG. 88.77 Three views show extensive calculusformation and an ill-fitting restoration on the loweranterior teeth of a 51-year-old man. Notice the traumacaused by the deposits on the sublingual soft tissueseen after the restoration was removed.4702 FIG. 88.78 Two views show extensive calculusformation under the restoration on the lower anteriorteeth of a 44-year-old man. Notice the trauma causedby calculus on the sublingual soft tissue seen afterremoval.FIG. 88.79 Subgingival margin locations and lack of4703 interproximal embrasures of the crowns causedgingival inflammation in a 29-year-old man.FIG. 88.80 Two views show the results of misuse offerric sulfate during gingival retraction, which causedburns and desquamation in a 30-year-old man.FIG. 88.81 Two views show iatrogenic use of abonding agent for the treatment of dentinalhypersensitivity, causing gingival recession in a 32-year-old woman.4704 FIG. 88.82 Trauma and inflammation of the soft tissueswas caused by the brackets in a 14-year-oldorthodontic patient.FIG. 88.83 Gingival trauma was caused by the ligaturewire in a 12-year-old girl.4705 FIG. 88.84 Gingival recession was associated withvigorous toothbrushing in a 48-year-old man.FIG. 88.85 Gingival desquamation after a 21-year-oldwoman rinsed with cologne.4706 FIG. 88.86 Hyperkeratosis was associated withsmokeless tobacco use in a 42-year-old man.FIG. 88.87 Desquamation was associated withtoothbrushing with soap in a 55-year-old man.4707 FIG. 88.88 Trauma and desquamation occurred afterplacing plant seeds on the gingiva for a toothache in a41-year-old man.FIG. 88.89 Gingival recession was associated withhabitual scratching of the gingiva with a nail in a 26-year-old woman.4708 FIG. 88.90 Gingival recession was associated withhabitual cleansing with tissue in a 42-year-old woman.FIG. 88.91 Desquamation and burn occurred after a50-year-old man rinsed with raki, a Turkish drink with a40% to 50% alcohol content.4709 FIG. 88.92 A traumatic lesion resulted from placingfresh garlic onto the aching third molar in a 26-year-oldman.Cysts and TumorsFIG. 88.93 A fibroma in a 45-year-old man had a firmand nodular character.4710 FIG. 88.94 Two views show a fibroma in a 56-year-oldman. (Courtesy Dr. Burcu Cam and Dr. Onur Ozcelik.)FIG. 88.95 A papilloma occurred in a 27-year-oldwoman.4711 FIG. 88.96 A papilloma developed on the palatal tissuein a 42-year-old woman.FIG. 88.97 Two views show severe, generalizedhuman papillomavirus–associated warts in a 7-year-oldchild.4712 FIG. 88.98 A peripheral giant-cell granuloma was seenin a 31-year-old woman.FIG. 88.99 An ameloblastoma occurred in a 54-year-old woman.4713 FIG. 88.100 An ameloblastoma was seen in a 49-year-old patient.FIG. 88.101 Squamous cell carcinoma was detected ina 62-year-old patient.4714 FIG. 88.102 Malignant melanoma was seen in a 52-year-old woman.Chronic Periodontitis4715 FIG. 88.103 Two views show plaque and calculus thatcaused chronic periodontitis in a 42-year-old manwithout any systemic diseases. Notice the generalizedradiographic bone loss.4716 FIG. 88.104 Two views show gingival recession,mobility, migration, and extrusion of teeth due toalveolar bone loss in a 48-year-old man with chronicperiodontitis.4717 FIG. 88.105 Advanced chronic periodontitis was seenin a 54-year-old man who had hygiene neglect andsmoking as contributing factors.FIG. 88.106 Generalized bone loss occurred in a 38-year-old woman with moderate chronic periodontitis.4718 FIG. 88.107 Two views show generalized bone lossthat occurred in a 45-year-old male smoker withadvanced chronic periodontitis.4719 FIG. 88.108 (A) Cone-beam computed tomographyshows generalized bone loss in a 39-year-old man withadvanced chronic periodontitis. (B) Two views showthe patient before and 4 months after initial periodontaltherapy and extraction of mandibular incisors (bottom).There is closure of the diastema between the maxillarycentral incisors after therapy.4720 Chronic Periodontitis Modified by SystemicFactorsDiabetes MellitusFIG. 88.109 Severe gingival inflammation andperiodontal abscess occurred in a 26-year-old womanwith type 1 diabetes mellitus. Notice the extrusion ofthe maxillary left central incisor caused by alveolarbone loss.FIG. 88.110 Severe inflammation, pus formation, and4721 periodontal breakdown occurred in a 34-year-old manwith uncontrolled type 1 diabetes mellitus.FIG. 88.111 Two views show the dentition of a 14-year-old girl who was referred with a complaint of toothmobility. She had spontaneous loss of teeth #11, #31,4722 #41, and #46 in the past 2 years. The patient hadadvanced bone loss despite a minimal amount ofbacterial plaque and degree 3 mobility of many teeth.She was diagnosed with type 1 diabetes mellitus onconsultation.FIG. 88.112 Three views show alveolar bone loss andsevere inflammation with spontaneous bleeding, pusformation, and abscess in a 56-year-old man with type2 diabetes mellitus who used external insulin for 12years.4723 FIG. 88.113 A 28-year-old woman with uncontrolledtype 1 diabetes mellitus was referred with complaintsof rapid mobility of teeth, severe pain, spontaneouspus, and several abscesses. Her fasting glucose levelwas 486 mg/dL on the day of referral. (A) Although thelesions resembled abscesses of periodontal origin, thepocket depths and attachment levels were withinnormal levels. (B) The computed tomography findingsand consultation with the infection departmentconfirmed the diagnosis of osteomyelitis. (C) View ofthe patient after 1 week of blood glucose control in theintensive care unit and hyperbaric oxygen therapy. (D)Although the lesions healed uneventfully, severemalocclusion was evident at the 1-year follow-upexamination.Aggressive Periodontitis4724 FIG. 88.114 Three views show aggressive periodontitisin a 3-year-old boy without systemic diseases. There issevere alveolar bone destruction of deciduous molarteeth.4725 FIG. 88.115 Two views show extrusion of the leftcentral incisor in a 21-year-old man with localizedaggressive periodontitis. There is severe breakdown ofalveolar bone of the incisor and mandibular first molar.4726 FIG. 88.116 Three views show advanced bone loss inan 18-year-old boy with aggressive periodontitis.4727 FIG. 88.117 Two views show intrabony defects in a 24-year-old woman with aggressive periodontitis.4728 FIG. 88.118 Five clinical and cone-beam computedtomography views show advanced alveolar boneresorption around the incisors and first molar in a 24-year-old man with aggressive periodontitis.4729 4730 FIG. 88.119 Clinical and radiographic views of a 27-year-old man show generalized aggressiveperiodontitis at (A) the initial visit and (B) the 5-yearfollow-up examination after therapy. Cone-beamcomputed tomography views show (C, D, and F)advanced alveolar bone resorption around incisors, (E)premolars, and (G) first molar.Periodontitis as a Manifestation ofSystemic DiseasesLeukemias4731 FIG. 88.120 A 12-year-old girl was referred withcomplaints of rapid swelling on (A) the face and (B) thegingiva, and (C) spontaneous bleeding. The patientalso had persistent fever and general malaise for 2weeks. (D) Radiographic analysis revealed alveolarbone loss and separation of the roots of the maxillaryright lateral and canine. Consultation with thehematology department and histologic analysis of thelesion confirmed the diagnosis of granulocyticsarcoma, which can precede acute myelogenousleukemia. (E) Histologically, infiltration of atypicalmyeloid cells into the gingival tissues was evident(hematoxylin and eosin; original magnification ×100).(F) The lesion regressed significantly after two coursesof chemotherapy. (From Antmen B, Haytac MC, Sasmaz I, Dogan MC,Ergin M, Tanyeli A: Granulocytic sarcoma of gingiva: an unusual case with4732 aleukemic presentation. J Periodontol 74:1514–1519, 2003.)FIG. 88.121 A 14-year-old boy was referred withcomplaints of rapid mobility of teeth, gingival swelling,persistent fever, and joint pain. (A) Clinical examination4733 revealed gingival hyperplasia in accordance with theexpansion of jawbones and third-degree mobility inmany teeth despite minimal bacterial plaque. (B) Bonemarrow aspiration biopsy revealed cytoplasmicvacuolization of lymphoblasts specific for acutelymphoblastic leukemia type L3 (May-GrünwaldGiemsa stain; original magnification ×100). (C)Radiographically, there was severe bone loss,abnormal trabeculation, and radiolucent areas aroundroots, which was more prominent on the molar teeth.(From Haytac MC, Antmen B, Dogan MC, Sasmaz I: Severe alveolar bone lossand gingival hyperplasia as initial manifestation of Burkitt cell type acutelymphoblastic leukemia. J Periodontol 74:547–551, 2003.)FIG. 88.122 Two views show alveolar bone destructionand gingival enlargement around teeth #41, #42, and#43 in a 15-year-old boy with acute lymphocyticleukemia.Genetic Disorders4734 FIG. 88.123 A 16-year-old girl who had been receivingtreatment for neutropenia for 8 years was referred forgingival inflammation. Two views show severemalocclusion and gingival inflammation, spontaneousbleeding, deep periodontal pockets up to 15 mm, andadvanced radiographic alveolar bone loss.4735 FIG. 88.124 An 11-year-old girl with leukocyteadhesion deficiency was referred to the periodontologydepartment. She had recurrent skin, ear, upperrespiratory tract, and lung infections since earlychildhood and was diagnosed with leukocyte adhesiondeficiency (LAD) 4 years earlier. She had one kidneysurgically removed due to infection. Two views showsevere periodontal breakdown with spontaneous lossof many teeth and advanced bone loss, deep pockets4736 up to 15 mm, and mobility for the remaining teeth. Thepatient's elder sister, who was 14 years old, also hadLAD and was diagnosed during the same period. Theelder sister's periodontal status is shown in Fig.88.125.FIG. 88.125 Two views show leukocyte adhesiondeficiency in a 14-year-old girl.4737 4738 4739 FIG. 88.126 Three views show hyperkeratosis of thepalms, loss of anterior teeth, gingival recession, andextensive radiographic alveolar bone loss of deciduousteeth in a 3-year-old boy with Papillon-Lefèvresyndrome.4740 4741 FIG. 88.127 Three views show effects of Papillon-Lefèvre syndrome in a 12-year-old girl, includinghyperkeratosis of the palms and soles. The patient hadspontaneous loss of many teeth and deep pocketsranging from 4 to 12 mm on the remaining teeth.Severe alveolar bone destruction is seen in thepanoramic radiograph.FIG. 88.128 Three views show skeletal deformities andgingival inflammation in a 14-year-old girl withhypophosphatasia.Necrotizing Periodontal Diseases4742 FIG. 88.129 Typical punched-out appearance of thegingiva (arrow) in necrotizing ulcerative gingivitis(NUG) is seen in a 25-year-old man.FIG. 88.130 Two views show a necrotizing ulcerativegingivitis lesion before and after removal ofpseudomembrane in a 27-year-old woman.4743 FIG. 88.131 Two views show a crater-like lesion andpseudomembrane formation on the palatal gingiva in a31-year-old man with necrotizing ulcerative gingivitis.4744 FIG. 88.132 Three views show severe necrotizingulcerative gingivitis (NUG) and a necrotizing ulcerativeperiodontitis (NUP) infection that caused extreme painin a 22-year-old woman on the first, third, and seventhday of referral. Rapid soft tissue destruction exposedthe alveolar bone.Bisphosphonates4745 FIG. 88.133 Zoledronic acid–related osteonecrosisoccurred in a 54-year-old woman who had been usingthe drug intravenously for breast cancer. The lesionoccurred 1 month after extraction of tooth #36.4746 FIG. 88.134 Three views show rapid gingival and bonenecrosis 1 month (top left), 2 months (top right), and 7months (bottom) after scaling and root planing in a 52-year-old woman receiving intravenous zoledronic acidafter breast cancer treatment.Abscesses of Periodontium4747 FIG. 88.135 Two views show a periodontal abscess ofthe left central incisor in a 21-year-old woman withaggressive periodontitis.FIG. 88.136 Periodontal abscess of the maxillary firstmolar occurred in a 35-year-old man with chronicperiodontitis.4748 FIG. 88.137 Two views show a periodontal abscess ina 39-year-old woman before and after treatment.FIG. 88.138 Pericoronitis is seen around a partiallyerupted mandibular third molar in a 19-year-old girl.Endodontic-Periodontal Lesions4749 FIG. 88.139 Two views show an endodontic-periodontal lesion in a 36-year-old man.FIG. 88.140 Two views show an endodontic-periodontal lesion in an 18-year-old girl.4750 IndexPage number followed by f indicates figure, by t table, and by b box.AAAP, American Academy of PeriodontologyABBM, Anorganic bovine bone-derived mineralAberrant frenum, problems, 661Abfraction, 390f, 391Ablation, 688–689Abrasions, 390, 390f, 583.e10Abrasive dentifrice, usage, 514fAbscessesclassification, 493clinical photograph, 853fperiodontal origin, e91fAbsolute anchorage, 583.e14Absorbable gelatin sponge, 601Absorbable hemostatic agents, 601tAbsorption coefficient, laser, 691fAbundant keratinized tissue, presence, 615f–616fAbutment4751 color shift in, 780bdesign and emergence profile, 779–780, 779fmargins, 779–780, 779f–780f, 780bmaterial selection, 777–779, 778f, 779bAC, Acellular cementumAcceleDent device, 583.e21Acceleration, orthodontics, 583.e20–583.e21, 583.e20bstimulatory devices, 583.e20–583.e21surgical methods for, 583.e20Accessibility, 545.e1, 545.e1bAccessory binocular module, 685fAccessory pulpal canals, presence of, 327Accessory root canals, prevalence of, 498–499Accidental damage, 61Accidental traumatic lesions, e79Accumulated glycation end-products (AGEs), 211Acellular afibrillar cementum, 38Acellular cementum (AC), 38farrangement, 38formation, 38Acellular extrinsic fiber cementum, composition, 39Acetaminophen (Tylenol), use of, 505.e4Achromatic lenses, 684Acoustic steaming, 546Acoustic turbulence, 546Acquired coatings, 27Acquired deformities/conditions, 56b, e48b–e49bAcquired immunodeficiency syndrome (AIDS), 365, 456.e3acute gingival disease, 491b4752 advanced, periodontal health (appearance), 372fHAART, usage, 376health status, 372–373infection control measures, 373maintenance therapy, 373necrotizing ulcerative periodontitis and, 362, 362bpsychologic factors, 373therapy, goals, 373Acquired pellicle, 123Acrylic provisional fixed full-arch prosthesis, clinical photographof, 742fActinobacillus actinomycetemcomitans, levels, elevation, 465Actinomyces odontolyticus (colony morphology), 114f–115fActinomyces oris MG1 in vitro, coaggregation, 125fActinomyces viscosusbranches, 114f–115froot surface caries microorganism, 311Active diseaseadjunctive orthodontic therapy, 698control of, 697–698, 697bemergency treatment, 697hopeless teeth extraction, 697oral hygiene measures, 697periodontal surgery, 697–698reevaluation, 697, 698fresolution, 697fscaling and root planing (SRP), 697, 697fActive eruption, 32Activities of Daily Oral Hygiene (ADOH), index, 476.e2Acusection, 606Acute abscess, 4964753 antibiotic therapy, indications, 496bchronic abscess, differences, 493external incision, drainage, 496periodontal pocket, drainage, 496tooth elevation, 495fAcute anginal attacks, nitroglycerin (usage), 444Acute gingival disease, 271bacquired immunodeficiency disease (AIDS), 491bcase scenario, 492.e1b, 492.e1ftreatment, 488–492, 491bAcute gingival infections, 268–276, 276.e1b, 276.e1fAcute herpetic gingivostomatitis, 275b, 282f, 491treatment, 492fAcute inflammation (initiation), neutrophils (impact), 160, 161fAcute inflammatory enlargement, 257Acute leukemiaappearance, 635fperiodontal ligament/alveolar bone (involvement), 216, 217fAcute lymphoblastic leukemia, appearance, 285fAcute lymphocytic leukemia, e98fAcute myelocytic leukemia, 215fanterior view/palatal view of, 217fAcute myelogenous leukemiaafter remission induction chemotherapy, e67fgingiva/floor, enlargement, e62fgingival hyperplasia/spontaneous bleeding, e62foral cavity, candidal infection, e67fsoft/hard tissue destruction, mucormycosis (impact), e67fAcute necrotizing ulcerative gingivitis (ANUG), 268differential diagnosis, reassessment, 491drugs, role, 490–4914754 first visit, 488–489gingiva, contouring, 490initial therapy, goals, 488blocal therapy, inadequacy, 491patient instructions, 489recurrent cases, persistent, 491second visit, 489–490systemic disease, 491third visit, 489–490treatment, 488, 490fconsiderations, 490–491gingiva, reshaping, 490fAcute pericoronitis, 492treatment, 492Acute phase proteins, 163.e1Acute respiratory distress, 453.e2Acute respiratory infections, periodontal disease and, 235.e4Acute streptococcal gingivostomatitis, lip/gingiva lesions, e65fAcute trauma, 328–329, 329b, 339ADA, American Dental AssociationAdaptation, 545.e5–545.e6, 545.e5b–545.e6bAdaptive immunity, 106–109Addison disease, 252Additive osseous surgery, 636impact, 637fAdditive process, of implants, 733.e3, 733.e3f–733.e4fAdenosine-citrate-dextrose acid (ACD-A) anticoagulant, 665Adhesion capacity, differences (microscopic confirmation), 118fAdhesive dentistry, 700fAdhesive surface proteins, 1494755 Adipose cells, 28Adjacent teeth, roots, 706fAdjunctive therapy, 565f, e8bcombination adjunctive therapy, e29–e30consideration, e30idea, data support, e27bimpact, e32orthodontic, 582–584, 698SRP, differences, e26Adrenal crisis, 450.e1, 450.e1bAdrenal insufficiency, 450.e1–450.e2Adult blood pressure, classification, 443tAdult gingivaappearance, 20fclinical appearance, 30fmelanotic pigmentation, 30fAdult oral sedative premedication, usage, 436bAdult periodontitis, 283Adult sedation, 432–434Advanced alveolar bone resorption, clinical/cone-beam computedtomography, e95fAdvanced bone loss, 655f, 854faggressive periodontitis, presence, e93fbacterial plaque, impact, e89fpresence of, mesial root resection, 658.e6fresection of, 658.e1fAdvanced chronic periodontitis, e51fhygiene neglect/smoking, contributing factors, e86fAdvanced gingivitis, 247fAdvanced glycation end products (AGEs), 3504756 Advanced horizontal bone loss, 583.e3–583.e4Advanced lesion, 93–94, 93fAdvanced periodontitis, pocket wall (bacterial penetration), 118fAdvanced radiographic alveolar bone, observation, e99fAegina, Paul, eiAerosol production, 549, 549bAesthetic tissue management, 702–703Aesthetic zone, 702, 663.e18implant placement, 857Aesthetics, 583.e7augmentation surgery, 819b, 818.e1complications, 846, 856–857, 857b, 857fdiffuse melanin pigmentation, e51fexamination, components, 820final outcome, 818.e1outcome from intraoral and extraoral, 711fpredictable, surgical strategy for, 818problemsgingival recession, 854fmelanin pigmentation, e51fresults, 871–872success, 872surgical aesthetic goal, level of, 818f, 818.e1, 818.e1ftissue preservation in, 818.e1After Five curette, 536–537, 537fGracey curette, comparison, 537fMini Five curette, comparison, 537fAfunctional atrophy, 47Agammaglobulinemia, presence of, 214f, 218.e2Agar plates, periodontal/cariogenic species, 114f–115fAGEs, Accumulated glycation end-products4757 Aggregatibacter actinomycetemcomitans, 71, 195, 445colonization, 353complement evasion, 150counts, 184–186etiologic agent, 410–411growth, 114f–115finhibition, tetracyclines (usage), 557involvement, 283isolates, 131–132LtxA production, 149prevalence, 363primary etiologic agent, 146–147role, decrease, 52strain JP2, 358translocation, 132Aggressive periodontitis, 56b, 65–68, 147, 283, 352–360, 479–487,e48b–e49b, e92advanced bone loss, e93falveolar bone destruction, 322, 325banterior dentition (image), 558fantibiotic therapy, 485tantiinfective therapy, considerations, 359antimicrobial therapy, 480–486appearance, 284fbacterial challenge, host response, 358–359case definition, 355–356case scenario, 487.e2f, 360.e1b–360.e2b, 360.e1f–360.e2f, 487.e2bchronic periodontitis, differences, 65–68classification, 352–355clinical characteristics, 352–355cyclic neutropenia and agammaglobulinemia, presence of, 214fdental implants, usage, 486–487, 487bdiagnostic criteria, 353tepidemiology, 355–3584758 features, 352–353full-mouth disinfection, 486full-mouth radiographs, 482f–483fgeneralized form, 65–68, 283geneticsfamily studies, 359polymorphisms, 359GLT6D1, association, 177host modulation, 486host response, 358–359implant therapy, 360independent gene association reports for, 176tintraoral clinical photographs, 482f–483flocal delivery, 486localized aggressive periodontitis, 146–147localized form, 68bmicrobial testing, 485–486microbiology, 358oral rehabilitation, 360panoramic image, 557fpathobiology, 358–359periodontal maintenance, 487periodontal therapy, 480postoperative radiographs, 485f, 558fpreoperative radiograph (anterior mandible), 558fprevalence, assessment, 355–356probing depths, 69fprognosis, 479, 480bregenerative therapy, 480risk factors, 358–359subgroups, 353–355supportive periodontal therapy, 359–360surgical resective therapy, 480surgical therapy, 359susceptibility, environmental factors, 3594759 systemic diseases, absence, e92ftherapeutic considerations, 359–360, 359btherapeutic modalities, 479–486treatment, 479–487planning/restorative considerations, 486–487systemic tetracycline, usage, 485bunderstanding, 358Aging, biological effects, 54bAgranulocytosis, 213–214, 453characterization, 271AHA, American Heart AssociationAI-2 (strain-specific competence-stimulating peptides)functions, 130production/detection, 130AIDS, Acquired immunodeficiency syndromeAir-powder polishing, 544–545, 544fAirway status, 461fAlbright syndrome, Polyostotic fibrous dysplasiaAlbucasis, eiAlbucasis periodontal instruments, eiifAlcohol abuseCAGE test, 478.e1fdiagnosis, 478.e1Alcohol consumption, 476.e3Alcoholism, 478.e1Alendronate (Fosamax), 221tAlertness/sedation scale, observer assessment, 439tAllele, 168t–169tAllergies, e78, e78foutpatient surgery, 6024760 Allogenic bone graft, usage, 74fAllogenic bone-grafting materials, 651.e2Allogenic succession, 140Allografts, 645, 651.e2tAlloplastic bone-grafting materials, 651.e2Alloplasts, 651.e2tAl-Tasrif, eiAltered passive eruption, 663.e20Alveolar bone, 47aging, impact, 52cancellous portion, 43–44CEJ (relationship), periapical radiographs (usage), 397–398destruction, e98faggressive periodontitis, 322mucormycosis infection, impact, e68fpanoramic radiograph, e103fdevelopment, 47heightloss, panoramic radiograph of, 592fvertical increase, 813involvement of, 216leukemic infiltrate, 216floss, 390.e1appearance, e86fexternal insulin and, e90fmetabolism, periodontal ligament (impact), 52morphologic changes, 52morphology, 637remodeling, 45–46resorption, 101–102stimulation, slightly excessive pressure, 330space, requirement, 746bvariation in, 321vertical bitewing films, usage, 399f4761 Alveolar crestapical position, 312–313fiberscoronal radiation, 34foblique extension, 34Alveolar dimension, 748fAlveolar mucosa (AM), 31fAlveolar process, 41–46, 591components, 41divisibility, 41knife-edge alveolar process, 788remodeling, 43sockets in, 592Alveolar ridgeconstruction, 698.e2, 698.e5f–698.e6fdefect, 76fevaluation, 764, 764f–765fextractions, management of, 802–803delayed implant placement for, 802–803immediate implant placement for, 803, 804fstaged implant placement, 803loss, 591fclinical image, 74fpreservation, 698.e1, 698.e2fAmalgam, 196fretrofill, impact, 62fAmeloblastic epithelium, reduction, 27Ameloblastoma, appearance, e84fAmerican Academy of Oral and Maxillofacial Radiology,recommendation, 766bAmerican Academy of Pediatric Dentistry, 5tAmerican Academy of Periodontology (AAP), 5t, evii4762 American Dental Association (ADA), 5tconscious sedation policy statement/guidelines, 431–432Council on Scientific Affairs, 520.e2–520.e3sedation usage/general anesthesia, 432guidelines, 432American Heart Association (AHA), 5tAmerican Society of Anesthesiologists Physical Status ClassificationSystem, 434tAmine fluoride, 529Amino groups, 194Aminobisphosphonate medications, therapeutic uses, 221tε-aminocaproic acid (Amicar), 452Amlodipine-associated gingival enlargement, e64fAmniotic fluid levels, in experimental periodontitis, 235.e2fAmoxicillin, 485b, 560use of, 505.e4Amoxicillin-clavulanate potassium, 560, 487.e1Anamnesis, 524Anatomic area, schematic diagram, 755fAnatomic crown/root, distinction, 32Anatomic factors, 419impact, 411Anatomic location, 869Anatomic spaces, 595–598Anatomic structures, identification, 753b, 762, 762bAnchor suture, 614.e2Anchorage, 583.e14–583.e15direct, 583.e14f–583.e15f, 583.e19indirect, 583.e15f–583.e16f, 583.e194763 Anemia, e62f–e63f, 218.e1, 218.e1f, e62Anesthesia, 600discovery of, eiii–eivAnginal episode, 444–445Angiogranuloma, 263Angioplasty, 445Angiotensin-converting enzyme (ACE) inhibitors, 445Angular bone lossexistence, 641furcation, involvement, 400fmandibular molar location, 400fAngular cheilitis, 220.e1severe, 367.e2fAngular defects (bone), 322–325Angulation, 545.e6–545.e7, 545.e6bAniacinosis, 220.e1Animals, mitotic rate, 27.e1Ankyloblepharon, 294Ankylosis, 41results, 41.e1Anorganic bovine bone-derived mineral (ABBM), 808Anosmia, 524.e1–524.e2Anoxemia, 245ANRIL, 351Anterior aesthetic surgery, 704.e2, 704.e2f–704.e3fAnterior gingival tissues, initial view, 489fAnterior open-bite, malocclusion, e54fAnterior-posterior (A-P) implant spread, 783.e1, 783.e1f4764 Anterior sector, moderate-to-severe periodontitis in, 588–589Anterior teethloss, e102fmobility, 457–458Antibioticsagents, 559bacteriostatic versus bactericidal, 556bprophylaxis regimens, 446tresistance, 487.e1selection (decision tree), 562fserial/combination antibiotic therapy, 561–563systemic administration, 556–561background/rationale, 556–557tetracyclines, 557–559usage, 556t, 505.e2–505.e3guidelines, 561–563Antibodies, 109Antibody deficiency disorders, 218.e2Anticoagulant, 454medications, 452, 453bAnticonvulsants, 260Anticytokine drugs, development, 573.e1Antigen-presenting cells, 106Anti-infective agentchemotherapeutic agent, 556definitions, 556Antiinflammatory cytokines, 100Antiinflammatory mediators, 565.e2Antimicrobial agents, delivery, drawbacks, e11Antimicrobial peptides, 157–158in periodontitis, 158, 158b4765 Antimicrobial resistance, biofilm (relationship), 131, 131bAntiplaque agents, usage, 477–478Antiplatelet medications, 452–454Antiretroviral therapy, 365.e4–365.e5, 365.e5bANUG, Acute necrotizing ulcerative gingivitisAnxiolysis, minimal sedation and, 439.e1–439.e4Aortocoronary bypass (cardiac bypass), 445Aphthous lesions, recurrent, e78fAphthous ulcers, recurrent, e66fApical abscesses, drainage from, 505.e3Apical diseasesclassification of, 501–502initiation of, factors of, 500–501Apical fibers, 34Apical vessels, branches, 48Apically displaced flap, 620–621, 631, 663.e6, 663.e8ffacial/lingual preoperative views, 620fselection, 620Apicoectomy, impact, 62fAplastic anemia, 218.e1appearance, 281fApneic episode, 458, 463.e2bArachidonic acid (AA), 160Arbitrarily primed-polymerase chain reaction, 131–132Arbitrary values, 87Archaea, 137Archetypal proinflammatory cytokine, 105Area-specific curettes, 534–539, 545.e8–545.e9, 545.e27f4766 curved blade, presence, 535–536universal curettes, comparison, 536tArg-gingipains, 149Arginyl-glycyl-aspartic acid sequences, 39.e1Argon laser, 689tAriboflavinosis, 220.e1Arterial blood supply, importance of, 594, 594fArterial oxygen tension, tissue oxygenation, 439, 439tArterioles, 29diagram, 29fArticulated diagnostic casts, 579Artzney Buchlein, eiiAspergillosis, 137tAspirin, 161, 452Aspirin triggered lipoxins (ATLs), 161Aspirin-induced chemical burn, 205fAssociationanalysis, 171–172, 172fspurious associations, schematic representation, 16fstudy, example, 166.e1t–166.e199tAssyrian clay tablets, eviAsthma, periodontal disease and, 235Atherosclerosis, 231coronary angiogram, 444fpathogenesis of, 231b, 231fperiodontal disease and, 228–233periodontal infection and, 232f, 233bAtherton tissue, 583.e18ATLs, Aspirin triggered lipoxins4767 Atopic dermatitis, pruritic lesions, e75fAtraumatic microsurgical tissue manipulation, 681fAtrophic lesions, 291Atrophic lichen planus, impact, e72fAtrophic periodontal ligament, 48fAtrophy, 32afunctional atrophy, 47disuse atrophy, 47Attached gingiva, 20, 386f, 389–390, 587–588appearance, 279fdemarcation, 30fistula, maxillary right first molar, 495fimpact, 21finterdental papillae, 21fmean width, 20fproblems, 660–661stippling, 31techniques, increase, 663.e1–663.e17variation, 277width, 20Attached plaque, 311Attachmentapparatus, development, 46–47level, 389, 389f, 390.e3floss, 312f, 389bone loss, relationship, 312pattern of, 655prevention of, 724–725, 725f–726ftreatment of, 725–726, 725f, 726bAttributable risk, 172percentage, 86–87Attrition, 3904768 Atypical ulcers (nonspecific oral ulcerations), 369Augmentationconvex ridge shape after, 708fmaxillary sinus, 813bsurgery, bone and soft tissue overbuilding, 819b, 818.e1Augmented reality, 842–844Autogenic succession, 140Autogenous bone, 808, 794.e3–794.e4Autogenous bone grafts, 645–646complications related to, 856.e1Autogenous bone harvesting, complications related to, 856.e1Autogenous monocortical block graft, harvesting, 797, 795.e2fAutografts, 645iliac autograft, 646.e2fAutoinducer 2, 130Autologous fibrin sealers, 664Autologous platelet concentration, 815.e1–815.e2Autologous PRP, use of, 647Automatic cardioverter-defibrillators, 442Automatic periodontal probing, 388.e1Autosomal dominant inheritance pattern, 168t–169tAutosomal recessive inheritance pattern, 168t–169tAutosome, 168t–169tAvascular necrosis, 221Avicenna, eiAvulsed teeth, replantation, 3fAxis II mental disorders, 339bAzithromycin, 487.e14769 administration, 629BBacillary (epithelioid) angiomatosis (BA), 368Bacilli, eii–iiiBack-action chisel, 607fBackground characteristics, 411–412Bacteria, reservoir for, subgingival environment as, 228Bacteria-host interactions (modulation), oral streptococci (impact),131Bacterial accumulation areas, 308Bacterial biofilms, 505.e2Bacterial challengehost response, 358–359schematic illustration of, 109, 110fBacterial deoxyribonucleic acid (DNA), 95–96Bacterial endocarditis, 445Bacterial endotoxin, 310bBacterial enzymes, 94impact, 130Bacterial pathogens, 210–211identification, 139–140Bacterial plaque, 52–53, eivimpact of, 653periodontitis and, 90Bacterial resistance, development (risk), 556–557Bacterial species, summary, 144t–145tBacterial transmission/translocation, 131–133Bacterial vaginosis, 235.e1–235.e24770 Bacteriumadherence, ability, 113biofilm mode of living, 117–129identification, molecular methods, 138initial adhesions/attachment, 124pathogenic bacteria, 142, 142tscanning electron micrograph, 123fsurvival, strategies, 116Bacteroides gingivalis, 80Bacteroides intermedius, 465Bad breathcause of, 524bdiagnosis of, terms for, 521b, 527bhormonal causes of, 523.e1metabolic disorders and, 523.e1Baking soda, 529Ball sickle scaler, 533, 606–607BANA test, 528.e1Bard-Parker knife, usage, 615Barrier membranes, 794.e2–794.e3nonresorbable, 794.e2–794.e3resorbable, 794.e3Bartholin duct, e55fBasal cell layer, 24fBasal lamina, 24fibrils, connection, 24internal basal lamina, 25Basement membrane, immunofluorescent-labeled antibodies, 60fBasic life support (BSL), impact, 435–436Bass method, 515f, 516b4771 Bass technique, 515–516B-complex deficiency, 220.e1–220.e2Behavioral considerations, 751Behavioral Risk Factor Surveillance System (BRFSS), 476.e6Behçet disease, e78fBeneficial species, 143Benign mucous membrane pemphigoid, 60fBenign paroxysmal positional vertigo (BPPV), crestal sinus lift and,856.e2Benzene intoxication, 224.e3Benzodiazepineintravenous administration of, 600.e1intravenous sedation, single, 439.e5–439.e6Benzothiazepine derivatives, 260Beriberi, 220.e1Berlin group, ev–eviBeta-adrenergic receptor antagonists (β-blockers), usage, 443–444types, 444tBevel incision, diagram, 610fBile pigments, 252Bioactive glass, 647.e1Biofilm, 112–150, 126baccumulation, 122–126antimicrobial resistance, relationship, 131bacteriacharacteristics, 129–131communication, 130case scenario, 150.e1b–150.e3bcontrol, 417–418checking of, 716–719evaluation, 8624772 implant examination, 860band patient education, assessment of, 396development of, 349heterogeneity, 117–119mode of living, 117–129resistance, 117visual examination of, 383, 383fBiofilm-induced gingival diseasemodified by medications, 422–423, 422f, 423bmodified by systemic factors, 422Biofilm-induced inflammatory periodontal diseases, 393, 393b, 393t,395tBiologic complications, 846, 852–856Biologic depth, 387Biologic mediators, usage of, 647–649Biologic plausibility, 11, 11bBiologic width, 699–702, 700b, 700f, 698.e1–698.e2evaluation, 700–701variations, 701fviolationscorrection of, 701.e1, 701.e1f–701.e2framifications of, 700frestoration design/shape (impact), e79fBiomarkers, 166Biomedical databases, 5BIONJ, Bisphosphonate-induced osteonecrosis of the jawBio-Oss (Osteohealth), usage, 646Bioresorbable membranes, 645.e2–645.e3Birbeck granules, 23Birth defectscause, 471bFDA drug classification system, 471b4773 Bisection-of-the-angle technique, long-cone paralleling(comparison), 398fBismuth gingivitis, appearance, 252fBismuth intoxication, 224.e3, 224.e3fBisphosphonate-associated osteonecrosis of the jaw, 221Bisphosphonate-induced osteonecrosis of the jaw (BIONJ), 221Bisphosphonate-related osteonecrosis of the jaw (BRONJ), 71, 221development, 750–751lesions, occurrence of, 221Bisphosphonates (BPs), 71, 220–223, 453–454, 566, e106bone-seeking agents, 566chemical structure of, 220fdiscontinuance, 73effects, 566impact of, 223, 223bBite size, microsurgery and, 687.e2, 687.e2fBite-wing radiographs, 398bexamples, 399fschematic diagram, 398fBiting, pain on, 504fBlack tongue, 220.e1Black triangle or hole, 663.e18, 663.e19fBlade adaptation, 545.e6fBlade angulation, 545.e6fBlade implants, 733.e1, 733.e1fBlast cells, release of, 214Blastomycosis, 137tBleeding, 216disorder (thrombocytopenia), 213f, 224.e4bgingivitis, clinical features, e494774 periodontal measures and, 82postoperative bleeding, clinical photograph, 849fproduction, periodontal surgery, 601reduction, saline solution cavitation (impact), 836spontaneousacute myelogenous leukemia, e62f–e63fdesquamation and, with erosive lichen planus, e72fhemophilia-A patient, e63fvon Willebrand disease, e64fBleeding points index, 520.e5Blisters, formation, e78fBlock graft, monocortical, 795–797, 797b, 798fBlock harvesting technique, 839.e4Blood dyscrasias, 453.e1gingival diseases associated with, e62gingival/periodontal disturbances, association, 213Blood supply, 29–30adequacy, 663Blood vessels, presence, 29.e1Blood viscosityfactors, 230fincrease, 229–230, 230fBlotter (Periopaper), 238B lymphocytes, 152tHIV and, 365.e2BMPs, Bone morphogenetic proteinsBonding agent, iatrogenic use, e81fBoneaction radius of, 319allografts, 646, 646bfreeze-dried, 646angular defects of, 322–3254775 architecture, correction (absence), 619autogenous, 808, 794.e3–794.e4availability, 806blend, 646.e1technique, 646.e1bulbous bone contours, 325calcified structure of, 794.e2cancellous, 646.e1contourconformation, 45fflap surgery, 641.e3fdeformities, 322distribution, 42fexposure, 613from extraoral sites, 646.e1–646.e2faciolingual diameter, 397formation, 734buttressing, 322furcation involvement, 325–327healing, initial, 733–734, 734b, 734fheavy ledges, presence, 641.e4inorganic matter/organic matrix, 42from intraoral sites, 646.e1marrow, 44metabolic disease, 750morphology, factors, 321–322necrosis, e107focclusal forces, transmission, 36osteoclasis, mesial root surface, 44fosteonectin, expression, 39.e1overbuilding of, in augmentation surgery, 819b, 818.e1pocket, relationship, 312–313quality, assessment, 762–763quantity/volume, assessment, 762–763regeneration, 645.e3f4776 remodeling and function, 734–735removal, 641.e4–641.e9by osteoplasty, 646.e1resorption, complexity, 43reversed architecture, 325, 325fsialoprotein, expression, 39.e1sounding, 611spatial relationship, 746–749swaging, 646.e1tap, 789, 789bunderlying, 587vascular supply, 48–49vertical defects, 322–325Bone apposition, 733.e7fBone augmentation, 806–813, 870, 816.e1b, 816.e1fachievement, 797–799bone grafts materials for, 808, 810fcrestal osteotomy technique for, 808–809, 809b–810b, 811fin flapless approachdental history and complaint, 820examination and diagnosis, 820, 821f–822fresults of, 822–823surgical procedure for, 822surgical strategy, 821–822treatment objectives, 820treatment options, 820–821, 820btreatment plan and rationale, 822treatment sequence, 822growth factors, 815.e1–815.e2horizontal, 795–797ePTFE barrier membrane, expansion, 796f, 795.e1fmonocortical block graft for, 795–797, 797b, 798fparticulate bone graft for, 795, 795.e1f–795.e2findications/contraindications, 806–807, 807bin labial flap reflectiondental history and complaint, 823.e1examination and diagnosis, 823.e1, 823.e2f–823.e3f4777 results of, 823.e4surgical procedure for, 823.e3–823.e4surgical strategy, 823.e2–823.e3treatment objectives, 823.e1treatment options, 823.e1–823.e2treatment plan and rationale, 823.e3treatment sequence, 823.e3lateral window technique for, 809–812, 812f, 812.e1fmaxillary sinus access, lateral window procedure, 812frisks and complications of, 812–813, 813bsimultaneous implant placement for, 807, 809f, 807.e1fsinus, complications related to, 856.e1–856.e3supracrestal/vertical, 813–815Bone chip harvesting technique, 839.e3–839.e4Bone destruction, 316–327, 316b, 398–402, 327.e1b–327.e2b, 327.e1f–327.e2fgingival inflammation in, 316–320mechanisms of, 320occlusion, trauma, 321patterns, 322–327, 399–402systemic disorders in, 320–321Bone grafts, 825–826materials, 808, 810f, 794.e3biologic properties of, 794.e3tpacking, 819fparticulate, 795, 795.e1f–795.e2fsubmerged position, 794–795Bone harvesting, Piezosurgery for, 839.e3–839.e4Bone loss, 316–327, 399advanced, 655fhorizontal, 322advanced, 583.e3–583.e4generalized, 400fmandibular implants, impact, 855fintraoral radiographs, 72f4778 peri-implantitis and, 853–854, 854f–855frate, 319–320severity, 312verticalmandibular implants (impact), 855fmovement, 323fBone mineral density (BMD) test, 224.e1Bone morphogenetic proteins (BMPs), 567, 651.e1, 815.e1Piezosurgery and, 833bBone ultrasound mappingadvantages and limitations of, 845.e1–845.e2, 845.e1tavailability of, 845.e2benefit of, 845case scenario, 845.e3brobustness/accuracy of, 845.e2safety of, 845.e2system risk analysis in, 845.e2Bone-substitute graft materials, 808Bone-to-implant interface, 734fBony architecture, types (diagram), 638fBony defectsconcave, 707fcorrection of, 707fBony depression, filling, 708fBony ledges (reduction), osteoplasty (usage), 640fBony lesions, anatomy of, 655Bony periodontium, photograph, 637fBony trabeculae, realignment, 47fBPPV, Benign paroxysmal positional vertigoBrånemark method, 705Breastfeeding, 4724779 antibiotic/sedative-hypnotic administration, 473tlocal anesthetic/analgesic administration, 473tBreath malodor, 521–530case scenario, 530.e1b–530.e3b, 530.e1f–530.e3fdiagnosis of, 524–527dry mouth, 523epidemiology of, 521.e2etiology of, 521–524intraoral causes of, 522–523masking, 530periodontal infections, 523preconsultation approach for, 524self-examination of, 527semantics and classification of, 521Breath odor, definition of, 521BRFSS, Behavioral Risk Factor Surveillance SystemBrill technique, 237Bristle brushes, 543, 543fBRONJ, Bisphosphonate-related osteonecrosis of the jawBrushite, 191Bruxism, 339, 463Buccal alveolar plate, cervical portion (variations), 46fBuccal depression, prosthetically guided orientation, 707fBuccal epithelial cells, double labeling, 123fBuccal exostosis, clinical photograph, 596fBuccal gingival grafting, 826, 826fBuccal lower premolar, bone (exposure), 73fBuccal mucosa, intraoral habitats, 117tBuccal space, 597Bulbous bone contours, 3254780 Bullous lesions (vesicular lesions), 291Bullous lichen planus, consideration, 297–298Bullous pemphigoid, 289t, 293–294appearance, 294fhistopathology, 293–294immunofluorescence, 294oral lesions, 294treatment, 294Bundle bone, 43teeth, physiologic mesial migration (association), 44fBundles, 33Bupropion, usage, 185bBurnsferric sulfate, misuse (impact), e80fraki and, e82fCCadaverine, 528.e1CADIA, Computer-assisted densitometric image analysisCAL, Clinical attachment levelCalcification, 192–193Calcium carbonate (CaCO3), 191Calcium channel blockers, 260Calcium intake, optimal, National Institutes of Health Consensus,474.e2bCalcium phosphate biomaterials, 647.e1Calcium sulfate, 651.e2–651.e3Calculus, 119, 190–195, 193b, 280b, 349–350, e52bridge-like formations, malocclusion (impact), e55fcementum and, 192b, 192f–193f, 195f4781 control toothpastes, 514delay healing, fragments of, 604deposits, rarity/increase, 280enamel and, 193fetiological significance of, 194–195extensive, radiopaque projection, e56fformation, 192–194, e54fdebridement/oral hygiene instruction, e59fextensive, e79fone-sided chewing and, e57fopen-bite neglect/hygiene neglect, e58fStensen duct, adjacent to, e55flocal factor, 418, 418bmineralization of, 194bacterial plaque in, 194microorganism in, 194versus oral hard tissues, 192tplaque and, 194fpresence, 411removal of, 507–508, 505.e1incompleteness, 314visual examination of, 383, 383f“Caldwell-Luc” procedure, 806Calf bone (Boplant), 646Calvaria defects, 164tCampylobacter rectus, 130Cancellous bonedestruction, 399marrow, transplants, 646.e1presence, 44proportions, 42fCancer therapies, 453–456Candida albicansinfection, 60–614782 overproliferation, 476.e7prevalence, 363Candidate genes, 170, 171tCandidiasis, 137t, 282, 476.e7diagnosis, 366–367techniques, 367flimitation, 302.e1oral, 366–367Canine fossa, 595–597Caninesdehiscence, 46fmesial surface, calculus/bone loss, 335fCanon, eiCantilever length, implant distribution (relationship), 783.e6fCapnocytophaga, 263Capnography, 439, 439bCapsulitis, 339.e2Carbon dioxide (CO2) laser, 689t, 691.e2, e52fCarboxy terminal telopeptide of type 1 collagen (ICTP), 569levels, time period correlation, 571.e1Carcinoma in situ, appearance, 476.e10fCardano, Girolamo, eiiCardiac bypass (aortocoronary bypass), 445surgery, 442Cardiac conditions, 446bCardiac pacemakers, 445, 549, 549bCardioselective beta blockers, 443–444Cardiotonic agents, 445Cardiovascular diseases (CVDs), 442–447, 163.e1–163.e24783 serum CRP/fibrinogen levels, elevations, 232systemic inflammatory component, 232Career-ending injuries, prevention of, 680fCaries, 419exposure, osteoplasty (usage), 640fCariogenic speciesgrowth, 114f–115fintraoral habitats, 117tCarious lesions, management of, 508Cartilage, 647.e1Case-control studies, 11–12, 85, 85t, 171t, 172Castroviejo microsurgical scalpel, 679fCastroviejo needleholder, 608fCat, tooth (eruption), 26f, 35fCathelicidin LL-37, 157CATs, Critically appraised topicsCause/effect, relationship, 12Causescomponent, 85necessary, 85sufficient, 85, 86fCavernous lesions, 406Cavitation, 546CBCT, Cone-beam computed tomographyCCDs, Charge-coupled devicesCDC, Centers for Disease Control and PreventionCDKN2B antisense RNA (CDKN2BAS), 175CDSSs, Clinical decision support systemsCEJ, Cementoenamel junction4784 Cell-cell adhesion, 124Cell-cell signaling (facilitation), biofilm mode of growth (impact),117Cell-mediated delayed-type hypersensitivity, 71Cell renewal cycle, 476fCell therapy, 651.e1Cellsintercellular matrix, 43layers, 25.e1suprabasal/subepithelial separation, e73ftissue engineering element, 647fCellular cementumarrangement, 38cementocytes, presence, 39fformation, 38Cellular elements, 28, 35Cellular innate responses, pathogen recognition and activation of,105, 105.e1t–105.e2tCellular intrinsic fiber cementum, 39Cellular mixed stratified cementum, composition, 39Cellular processes, hormonal regulation, 469Cellular proliferation, estrogen regulation, 469Celsus, Aulus Cornelius, eiCemental tears, 76–77appearance of, 329fCemented prostheses, 774–777Cementicles, 36Cementoblasts, 35, 152tCementodentinal junction, 394785 Cementoenamel junction (CEJ), 39tooth morphology, variation, 40fCementoid, 46Cement-retained implant crown, 775, 776fCementum, 38–41, 46aging, impact, 52attachment protein, role, 39.e1calculus, coverage, 311caries, attention, 311cellular resorption areas, 311collagen fibers, 33fdecalcification/remineralization, 310–311deposition, 39exposure, 41fiber, formation (clinical human histology), 41fformationimportance, 41initiation, 46fusion, 41organic matrix, 38permeability, 39protection and preservation of, 505regeneration, 41repair, 39–41requirements, 40–41resorption, 39–41, 41fcause, 40microscopic appearance, 40occlusal forces, association, 40fthickness, 39abnormalities, 39Centers for Disease Control and Prevention (CDC), 5tCentral apnea, 459obstructive apnea, differences, 459f4786 Central buttressing bone formation, 322Central incisorsopen embrasures, 583.e11roots, horizontal lines (appearance), 402ftriangular shape, impact, 583.e11fCentral nervous system (CNS) depressants, increase, 467Central sleep apnea, 459Central upper incisorscrack, 127foral hygiene (absence), 127fCentric relation, 337–338, 575assessment, 577–578bimanual manipulation, 578fload testing in, 340.e1finitial contact in, 576Cephalosporins, 560clinical use, 560pharmacology, 560side effects, 560CEPs, Cervical enamel projectionsCER, Control event rateCeramic Maryland bridge, for missing teeth replacement, 771fCeramic materials, prostheses, 865Cerebral infarction, periodontal disease, 232Cerebrovascular accident (CVA), 447Cervical abrasion, aggressive horizontal brushing, 61bCervical area, periodontal ligament, 332fCervical enamel projections (CEPs), 75, 655classification of, 655bextensions, 4194787 Cervical root resorption, 76–77computed tomography scanning, 76fCetylpyridinium chloride (CPC), 528, 520.e3CFTR gene, recessive mutations, 167Chair-side test, 528.e1Charge-coupled devices (CCDs), usage, 406CHD, Coronary heart diseaseChédiak-Higashi syndrome, 174b, 218.e2Cheek, aphthous lesions, recurrent, e78fChemically modifies tetracyclines (CMTs), 573.e1Chemokines (CXCs), 100, 159–160Chemotaxis, 186Chemotherapy, 455, 556usage, 477–478Chemotherapy-induced thrombocytopenia, 213fChewingimpaired, 476.e3pain and, 504ftobacco, 204–205, 207bChewing gumformulation of, 530impact of, 528CHF, Congestive heart failureChief complaint, 381Childhooddiseases, oral mucosa, 285gingival disease, 277–286, 286.e1b–286.e2b, 286.e1f–286.e2fperiodontal disease, 282–283Children4788 acute lymphoblastic leukemia, appearance, 285faggressive periodontitis, 284fchronic gingivitis, 280, 280bcongenital anomalies, 285diabetes mellitus, 283–284endocrine disorders, 283–284hematologic disorders, 284–285hormonal changes, 283–284immune deficiencies, 284–285neutrophil disorders, 285pediatric patient, therapeutic considerations, 285–286systemic disease, gingival manifestation, 283–285China, medical works of ancient, eiChisel scalers, 541–542, 541f, 545.e28–545.e29, 545.e28f–545.e29fChlorhexidine (CHX), 487, 529cationic bisbiguanide (usage), 477–478chip, e7, e14release profile, e14trial, e28–e29chlorhexidine-based products, e10gluconate chip (PerioChip), e8fChlorhexidine dilutions, 553tChlorhexidine mouth rinses, 206Chlorhexidine rinse, prescription of, 520.e3Chlorhexidine-soaked pellets, 780.e3fChlorine dioxide (ClO2), 529Chlo-Site, e10gel, e10fChord distance, 686–687, 687fChromosome, 168t–169tChronic abscess, 496–4974789 acute, differences, 493Chronic adult periodontitis, 283Chronic atrophic candidiasis, 476.e7Chronic cutaneous lupus erythematosus, 289t, 300appearance, 300fhistopathology, 300immunofluorescence, 300Chronic desquamative gingivitis, 287appearance, 288fdiagnostic approach, 288fimmunofluorescence, 288lichen planus, impact, 288management, 288–290microscopic examination, 288Chronic destructive periodontal diseases, progression modes(diagrammatic representation), 139fChronic diseases, 459complexity, 10Chronic gingivitis, 248appearance, 253fmarginal/interdental gingivae, appearance, 249fChronic gram-negative periodontal infections, 235Chronic inflammatory enlargement, 258anterior region, localization, 257fappearance of, 257fgingival, fibrotic component, 628survey section of, 259fChronic leukemia, Gleevec (usage), 376Chronic marginal gingivitis, 282fChronic myelogenous leukemia, gingival inflammation/hyperplasia, e62f4790 Chronic obstructive pulmonary disease (COPD), periodontaldisease and, 235.e3–235.e4Chronic oral malodor, 528Chronic periodontal abscess, appearance, 404fChronic periodontal destruction, 64Chronic periodontal disease, necrotizing ulcerative gingivitis(differentiation), 270tChronic periodontitis, 56b, 65, 146, e48b–e49b, e85–e88adult periodontitis, 283aggressive periodontitis, differences, 65–68antiinfective therapy and periodontal reevaluation, 345f–346fasynchronous, multiple-burst model for, 348bacterial infection, e7behavioral factors of, 351calculus, impact, e85fcase scenario, 351.e1b–351.e2b, 351.e1f–351.e2fcharacteristics of, 342–346chronic adult periodontitis, 283classification, 65bclinical features of, 342–349continuous model for, 348diagnostic criteria, 353tdiseasedistribution of, 346progression of, 348risk factors of, 349–351severity of, 346–347environmental factors of, 351generalized, 346bone loss in, e86f–e87fsevere, 416fgenetic factors of, 350–351genome-wide association studies (GWAS), 351gingivitis versus, 3464791 HIV and, 372immunologic factors of, 350independent gene association reports for, 176tlaser for, 693b, 694.e1–694.e2local factors of, 349–350localized, 346microbiologic aspects of, 349microbiologic examinations, 146mild chronic periodontitis, 347moderate chronic periodontitis, 347modificationsystemic condition (usage), 68systemic factors, e88myocardial infarction (association), two-by-two table (usage), 15tperiodontal attachment, documentation, 347fplaqueformation, extensive, e52fimpact, e85fpresence, e86fprevalence for, 348–349, 348f–349fprognosis, 423radiographic periodontal status of, 343frandom/episodic-burst model, 348retentive local factors that contribute to, 350severe chronic periodontitis, 347site specificity of, 348bsymptoms of, 347–348systemic factors of, 350treatment of, 234, 351Chronic trauma, 329, 329b, 339Chronic ulcerative stomatitis, 289t, 291t, 298–299, 299bappearance, 298fdiagnosis, 298–299direct immunofluorescence, 298f4792 histopathology, 298immunofluorescence, 298oral lesions, 298treatment, 299Cicatricial pemphigoid, 289t, 291t, 294–296, Mucous membranepemphigoiddifferentiation, 295treatment, 290fCiprofloxacin, 560clinical use, 560pharmacology, 560side effects, 560Circadian periodicity, 239Circular fibers, 28Circular punch, 790, 790fCitric acid, 645.e3–645.e4Civatte bodies, 292bClass III furcation defectorthodontic treatment, 583.e4preorthodontic treatment, 583.e5fClass III furcation involvement, clinical picture of, 659fClass III malocclusion, 583.e4fperiodontal destruction, e57fClassical/lectin/alternative pathways, 156, 157fCleansing instruments, 531, 543–545Clearing technique, usage of, 498–499Clindamycin, 560, 487.e1clinical use, 560pharmacology, 560side effects, 5604793 Clinical attachment level (CAL), 389, 389bdetermination, 414Clinical attachment loss, 389Clinical crown, periodontally compromised maxillary anteriorteeth, clinical photograph, 819fClinical decision support systems (CDSSs), e4–e5adoption, barriers, e5Clinical diagnosis, laboratory aids, 393Clinical evidence, research/levels (hierarchy), 6fClinical examination, 381–385, 764Clinical indices, in dental practice, 390.e1Clinical information, types, e2f–e3fClinical practice guidelines (CPGs), 5absence, 6Clinical probing, 404Clinical Queries (PubMed), usage, 7Clinical research, phases, e27tClinical risk assessment, 410–412Clinical selection, diagnostic imaging, 764–768Clinical significancelevel 1, 375–376, 376blevel 2, 376, 376blevel 3, 376–377, 376blevel 4, 377levels of, 374–377benefits, impact, 375tdefining, 375–377statistical significance, differences, e26–e27Clinical studies, e34Clinical trials4794 bias, minimization, e28patient assignments, impact, e28considerations, e34–e40designcharacteristics, e28tconsiderations, e27–e29endpoints, e28group comparability (minimization), patient assignments (impact), e28initiation, political issues, 17mean differences, e26objectives, e28statement, e28patient selection methods, e28protocol/statistical plan/reports, analysis methods, e28study drug effects (interpretability), results analysis (impact), e28–e29Clinical use, e29–e40adverse effects, e31cautions, e31indications, e29Clinically relevant endpoint, 13Clinically relevant pretrial hypothesis, 13Clinically relevant questions, design, 13Clinically significant, term, 374Clofibrate, usage, 377Closed-anchor suture, 614.e2, 614.e4fClosed-loop systems, e4–e5Clot formation, von Willebrand disease, e64fClot stabilization, 645.e4Cluster differentiation (CD), 651.e1CMTs, Chemically modifies tetracyclinesCoagulation disorders, hemorrhagic disorders, 450–453, 451t4795 Coagulation factors, 241Coagulation factor VIII, 229–230Coatings, developmental origin, 27Coaxial lighted prism loupes, 685fCoccidioidomycosis, 137tCochrane Collaboration, 5tCo-destruction, zone of, 333Coe-Pak, 602, 603fCohen syndrome, 350Cohort studies, 5, 11, 85, 85tColinterdental col, anatomic variations, 21fintervening col, 20fnonkeratinized stratified squamous epithelium (covering), 21fColitis, 164tCollagen, 27biosynthesis, occurrence, 33bundle, 34fcarriers, 651.e2composition, 33degradation, MMPs (relationship), 244fibers, 34fembedding, 33fsources, 38fibrils, 34floss, mechanisms, 305metabolism, altered, 211–212microfibrils, 34fmolecular configuration, 33organic matrix, 42synthesis, 334796 Collagenase, presence, 568–569Collagenase-1, 99Collagens, 651.e2tColor shift, abutment/restorative material, 780bColor-coded probe, 82Colorimetric test, 528.e1Combination adjunctive therapy, e29–e30Combination antibiotic therapy, 561–563clinical use, 561pharmacologic implications, 561–563rationale, 561Combination syndrome, 783.e1Combined antiretroviral drug therapy, 365.e5Combined lesions, 75Combined osseous defect, 322–325Common variable immunodeficiency disease (CVID), 218.e2Community-acquired bacterial pneumonia, 235.e4Compact bone, relative proportions, 42fComparisons, usage, 13Competence-stimulating peptides, 130Complement system, 156–157Complementary treatment strategies, 567finvolvement, 568Complement-pattern-recognition receptor signaling, 156Complex apnea, 459Component cause, 85Compound loupes, 684, 684fComprehensive periodontal management, host modulation4797 (relationship), 567–568Compromise osseous reshaping, 638Compromise osseous surgery, 641.e5fComputed tomography (CT) scan, limitations, 844.e1Computer-aided design/computer-assisted manufacture(CAD/CAM) technology, 783.e4Computer-assisted densitometric image analysis (CADIA), 642.e4Computer-generated surgical guides, 840Concave bony defects, 707fConcave proximal tooth surfaces, cleaning, 520fConcordance, 168t–169tConditioned enlargements, 262Conditions, occurrence of, measurement, 81–82Condylar displacement, 576Condylesabnormal anatomic features of, 339.e2movement of, 338.e1rotation of, 338f, 338.e1fCondyloma acuminatum, 369.e2fCone-beam computed tomography (CBCT), 406, 408b, 755, 755f–757f, 844.e1advantages/disadvantages of, 754t, 755, 755bimage, usage, 762f–763fview, e87fConfidence interval, range, 15Conflict of interestdefinition, 18impact, 18issues, 18protection, 184798 Confoundersmeasurement accuracy, 16statistical modeling, usage, 16Confounding, 15impact, evaluation, 16, 16bissue, absence, 15–16Congenital agammaglobulinemia, 218.e2Congenital heart disease, 224.e2Congenitally missing maxillary lateral incisors, radiographicevaluation, 763fCongestive heart failure (CHF), 445Connective tissue, 735–738breakdown, cytokine expression (impact), 250cellular/extracellular components, 27cuff, blood supply of, 739fexposedatrophic lichen planus, impact, e72fdesquamation, impact, e71ffibers, types, 27interface, examination, 736Connective tissue cells, 35stimulation, 565.e1Connective tissue graft (CTG), suturing, 682fConscious sedation, 431–441Contact stomatitis, 302Continuous tooth eruption, 32Contra-angled designs, 547, 548fContrast resolution, 757Control event rate (CER), 8Controlled evidence level, availability, 11–124799 Controlled-release antimicrobial productsavailability, e7development, e8tdrug class consideration, e7locally delivered, e7–e47Controlled-release local delivery, pharmacokinetics, e14Controlled-release rationale, e11–e14Conventional finger rest, 545.e4, 545.e4fConventional plastic tips, for oral irrigation, 520.e1fConvex ridge shape, after augmentation, 708fCOPD, Chronic obstructive pulmonary diseaseCoping, 218Coral-derived materials, 647.e1Core-Vent system, 733.e1–733.e2Corn cob, 126.e1fCorneocytes, formation, 22.e1Coronal cementum, 27Coronal integrity, 505.e3Coronally displaced flap, 663.e10, 645.e4, 663.e11fCoronary angiogram, 444fCoronary artery disease, periodontal disease and, 228–233Coronary heart disease (CHD)patient education, 235–236periodontal infection, influences, 225–226related events, 229risk of, 229Corrosion, 390Corticosteroids, 223–224, 454–455Cotton, as abutment screw cover, 780.e1, 780.e1f4800 Countersink drill, 786f, 789Coxsackievirus, 135tCPC, Cetylpyridinium chlorideCPGs, Clinical practice guidelinesCrater-like lesion, e105fCraterscorrection (effect), 639freduction, diagram, 641.e7fC-reactive protein (CRP), 163.e1acute-phase proteins, 232inflammatory marker, 53Crestal bone, 777resorption, osteoclasts/Howship lacunae, 319fsurface, inflammation extension, 319fCrestal incision, 610–612, 611f, 790, 790fCrestal osteotomy technique, 808–809, 809b–810b, 811fCrestal sinus lift, complications related to, 856.e2–856.e3Crevicular incision, 610–612initiation, 619Crevicular washings, use of, 237Critical analysis guides, examples, 8tCritical probing depth, 509Critically appraised topics (CATs), 6Cross-arch finger rest, 545.e4, 545.e4fCross-arch stabilization, 856.e3Crossbite, 392–393Cross-sectional imaging, 755–757, 766Cross-sectional studies, 227on LBW infants, 235.e2–235.e34801 Crown-lengthening procedures, 698.e1–698.e2, 698.e3f–698.e4f,698.e4blasers for, 692, 692fPiezosurgery for, 834–836Crownsaesthetic appearance, gingival margins (impact), 583.e9contours, 701formation, 46fracture, 76fgingival margin, relationship, 51finterproximal embrasures, absence, e80fmargin, overextension, 583.e6proximal surfaces, 31recontouring, 508Crown-to-root ratio, problems, 420fCRP, C-reactive proteinCryptococcosis, 137tCryptococcus neoformans, 136CTG, Connective tissue graftCurettes, 531, 533–539, 534bcharacteristics, 534ftypes, 534fCurrent illness, 381Curve Dental and Dental Symphony, e3Cushioning, occlusal forces, 320Cusp-fossa relationship, 576Cusp-marginal ridge relationship, 576Custom impression transfer coping, 827–828, 828fCustomized impression copings, 783.e1Cuticle, term (usage), 274802 Cuticular structures, 27classification, 27Cutting edge, 545.e23, 545.e24fCVA, Cerebrovascular accidentCVDs, Cardiovascular diseasesCVID, Common variable immunodeficiency diseaseCyclic neutropenia, presence of, 214fCyclooxygenase-2 (COX-2), 175inhibitors, usage, 566Cyclooxygenases (COXs), 160Cyclosporin A-induced GO, 260, 261fCyclosporinedrug substitutions, 629therapy, impact, 59fCyclosporine-associated gingival enlargement, intraoperative view,e65fCyclosporine-induced gingival enlargementnifedipine-induced gingival enlargement, combination (treatment), 633f–634fsurgical treatment, 632fCyclosporine-induced gingival hyperplasia, appearance, 281fCylindrical implants, 733.e1–733.e2, 733.e1f–733.e2fCysts, e83Cytokeratins, characteristic pattern (identification), 22.e1Cytokines, 96, 97b, 160, 305b, 573.e1antiinflammatory, 100expression, impact, 250IL-10 family of, 100Cytomegalovirus, solitary ulcer, in soft palate, 369.e1fCytoplasmic organelle concentration, variation, 22.e14803 DD series resolvins, 161DARE, Database of Abstracts of Review of EffectivenessDark-field microscopy, 527Data acquisition, in real-time micro positioning implant surgery,841–842, 842bDatabase of Abstracts of Review of Effectiveness (DARE), 5De novo plaque formation, 127–128, 127f, 129bpatient age, impact, 127–128subgingival, 129DeBakey tissue forceps, 607fDebridement, 508, 505.e1Deciduous teethmobility, impact, e53fmolar, alveolar bone destruction, e92fradiographic alveolar bone loss, e102fDecision-making pathway, 4fDecision support systems, e1–e6risk-based, e5types, e4–e5Deconditioning, 476.e3Deep furcation invasions, location, 494fDeep periodontal pocketappearance, e99flateral wall, ulceration area, 309fprobing, 304fsoft tissue wall, abscess, 314Deep sedation, 434, 434bDefect type, determination, 414Defense cells, 354804 Defensins, 101, 157α-defensins, 104β-defensins, 158β-defensins 1, 158β-defensins 2, 158Definitive osseous reshaping, 638Definitive trials, 84–85Dehiscence, 45, 661biologic complication, 852defects, 795b, 797, 799fDelayed implant placement, 802–803Demineralization areas, 311Demineralized freeze-dried bone allograft (DFDBA), 646, 808,794.e3, 645.e2f, 795.e1fDendritic cells, 152tDental anomalies, periodontium, 498Dental biofilm, development of, 349Dental calculusattachment of, to tooth surface, 192, 192f–193fcase scenario, 207.e1f, 207.e1tcomposition of, 191–192contours and open contacts in, 198–199, 198b, 199finorganic content of, 191–192, 192bmargins of restorations in, 196–199, 197f, 198bmaterials for, 199organic content of, 192predisposing factors of, 195–207, 195frole of, 190–207subgingival, 190supragingival, 1904805 Dental caries control, 520.e2, 520.e2bDental endoscope, 542–543, 543bDental examination, older adults, 476.e9bDental floss, 516–518holders, 517, 517fpositioning, 516ftechnique for, 516–518, 517fDental habits, destructiveness, 583.e10Dental history, 381, 746review (older adults), 476.e8Dental hypersensitivity, treatment for, 605.e1bDental implant microsurgery, 824–829Dental implants, 658, evi–eviicase types/indications, 741–744clinical evaluation of, 741–752custom abutments, 710fhealing abutments, 708finterproximal soft tissue cratering, bone necrosis, 694fplacement, surgical access, 712fprosthetic components, emergence profile, 710fradiograph, 709ftherapy, goal of, 741types, 848usage, 486–487, 487bDental materials, hypersensitivity to, 702Dental pain, identification, 339Dental plaque, 127bbacteriainteractions, 130–131, 131fmetabolism, 129–130nutrients, origination, 129bacterial proteolytic activity, 1494806 biofilmaccumulation, 122–126structure, 119–122, 120b–121bclassification, 120composition, 119gingivitis, association, 57–58, 423host, reaction, 333fmicrobial, e52composition, change, 126periodontal disease and, 86primary colonizers, 124tsecondary colonizers, 124tsupragingival dental plaque formation, factors, 126–129trichomonas, visualization, 137fDental-plaque-induced gingival diseases, 55–59Dental practices, EDR (usage), e1Dental pulpbiologic effects of periodontal infection on, 504–505occlusal forces on, effects of, 331–332Dental restorations/appliances, 75Dental stains, 195, 391Dental tape, 544Dental treatment, complications, 369Dental use, locally delivered controlled-release antimicrobialsdevelopment, e8tDental visits, older adults, 476.e6–476.e7Dentate state, 463Dentifrices, 514, 514bDentincellular resorption areas, 311protection and preservation of, 505resorption, 41f4807 Dentinal hypersensitivity, bonding agent for, iatrogenic use of, e81fDentinal tubules, bacteria (scanning electron micrograph), 123fDentinogenesis imperfecta, cause of, 173Dentistrymodern implant, 732, 732bprocedures, restorative, 199Dentitionwith jaws closed, 392–393terminal, to complete edentulism, 783.e2, 783.e3fvariation, 128Dentoalveolar ablations, 390Dentogingival area, leukocytes in, 240Dentogingival junction, 90Dentogingival unit, 25DentoRisk, e5Dentrix Dental Systems, e3Deoxyribonucleic acid (DNA)answers, 170–172band pattern, isolation, 132fexchange, 117intercellular exchange, 131variants, 172variation, inheritance, 166Depression, 218, 476.e4side effect, 444Deproteinized anorganic bovine bone, 808Deproteinized bovine bone mineral, 808Dermatitis herpetiformis, 289t, 299–300histopathology, 299immunofluorescence, 299–3004808 treatment, 300Desquamationferric sulfate misuse, impact, e80fformation, e78fsevere, e71fsoap toothbrushing and, e82fspontaneous bleeding and, with erosive lichen planus, e72fDesquamative gingivitis, 287–302, 302.e2b, 302.e2fbiopsy, 288chronic desquamative gingivitis, 287clinical examination, 287clinical history, 287clinical presentationconditions, 289t, 291tdiseases, 288conditions, mimicry, 302.e1, 302.e1bdiagnosis, 287–290gingival erythematous candidiasis, 366fpresentation, appearance, 292fDestructive mediators, elevations, 565.e2Developmental gingival enlargements, 265, 266fDevelopmental grooves, 419Developmental/acquired deformities/conditions, 56b, 65b, 75–77DEXA, Dual-energy x-ray absorptiometryDFDBA, Demineralized freeze-dried bone allograftDHA, Docosahexaenoic acidDiabetes mellitus, 208–212, 209b, 749–750bacterial pathogens, 210–211case scenario, 456.e4bcollagen metabolism, altered, 211–212complications of, 233bcontrol, laboratory evaluation, 448b4809 diagnostic criteria, 448bendocrine disorders, 447–450, 448fguidelines, 448–449gingival disease and, e88, e88f–e91fglycemic control, periodontal infection and, 234–235infections, association of, 208–212oral manifestations of, 209–210, 213bperiodontal condition, 210fperiodontal disease and, 233–235, 234brisk factor, 410polymorphonuclear leukocyte function, 211risk factor, 871role, 871type 1, 208–209type 2, 209Diabetic foot ulcers, L-PRF application for, 668.e1Diagnosischallenge in, 178definition of, 87Diagnostic imaging, 753–768, 768.e1b–768.e2b, 768.e1f–768.e2fclinical selection, 764–768, 764bcross-sectional, 755–757standard projections in, 753–755, 754tDiagnostic study models, 746, 746.e1fDiamond-coated files, 542, 542fDiamond sharpening cards, 545.e24Diastema, 691.e1felastics for, 201–202, 202fDiastolic blood pressure, 442Diazepammeperidine combined with, 439.e6technique, 439.e54810 DICOM, Digital Imaging and Communications in MedicineDietary Guidelines for Americans, 11bDifferential implant site preparation (DISP), 837Differentiation, 22Diffuse gingivitis, 248Diffuse localized melanin pigmentation, e52fDiffuse melanin pigmentation, aesthetic problems, e51fDigital Imaging and Communications in Medicine (DICOM), 755–756scan data, 760f–761fDigital intraoral radiography, 406, 407fDigital photographic documentation, 381Digital pressure, 496fDigitally assisted implant surgery, 840–845DIGO, Drug-induced gingival overgrowthDiode laser, 689t, 691.e1, 691.e1fDiphenylamine, 528.e1Diphtheria, necrotizing ulcerative gingivitis (differentiation), 271tDirect anchorage, 583.e14f–583.e15f, 583.e19Direct-to-consumer models, 180Direct vasodilators, 445Disc displacement, 339.e1, 339.e1fDischarge criteria, 438bDisclosing agents, 520.e3effect of, 520.e4fDisclusion, 575Discoid lupus erythematosus (DLE), 300Disease4811 activitydetermination of, 390.e1measurement, 561tests, 723definition of, 87health transition, 140–148, 140b, 141foccurrence, comparison, 167–169occurrence of, measurement, 81–82periodontitis, 173protection, AA genotype, 172rate, 81recurrence, symptoms/causes, 720trisk, biomarkers, 166risk factors for, 349–351Disk implants, 733.e1DISP, Differential implant site preparationDisplaced flaps, 614Disposable plastic prophylaxis angle, 543, 544fDistal flap surgery, 593Distal horizontal incisions, in maxillary tuberosity, 622bDistal pockets, treatment, 622Distal terminal molar flap, 618, 621–622Distal wedge suture, 614.e4fDistobuccal root resection, diagrams of, 658.e4fDistraction osteogenesis, 815.e1Disuse atrophy, 47Diuretics, 445Diverse pattern-recognition receptor (PRR) signaling pathways,156bDizygotic twins, disease occurrence (comparison), 167–169, 168t–169t4812 DLE, Discoid lupus erythematosusDNA, Deoxyribonucleic acidDocosahexaenoic acid (DHA), 160–161Dodecanol, 528.e1Dogexperimental occlusal trauma, 331fjaw, lamina dura (foramina perforation), 36fpigmented gingiva, melanocytes (presence), 23fDorsal tongue mucosa, irregular surface topography, 522Dosingincremental dosing, 433–434supplemental, 439.e5Double-ended curette, usage, 535fDouble-ended Gracey curettes, pairing, 535Double-papilla flap, 663.e10Down syndrome, 173Doxycycline, 559doxycycline-based products, e11–e14gel (Atridox), e7–e8, e9f, e14Ligosan Slow Release, e11, e12flow-dose doxycycline (LDD), 568sub-antimicrobial-dose doxycycline, 566Dramatic bone destruction, clinical picture/intraoral radiograph,147fDressingantibacterial properties of, 602removal of, 604–605findings at, 604retention of, 602Drillscountersink, 786f, 7894813 pilot, 786f, 788sequence of, 788f3-mm twist drill, 786f, 788–7892-mm twist drill, 786f, 788Drosophila, 94Drug-induced gingival diseases, e64Drug-induced gingival enlargement, 281, 281b, 628–631decision tree, 630fflap operation, 631gingivectomy technique, usage, 631fperiodontal flap treatment, 633frecurrence, 631treatment options, 629–631Drug-induced gingival overgrowth (DIGO), 256, 259–262, 259b–260bclinical correlation of, 262bhistopathology of, 260pathogenesis of, 260–261treatment of, 261–262Drug-induced hyperpigmentation, zidovudine use (impact), 369f4814 Drugsdevelopment, e14–e29phase, e27eruptions, 302registration, e14–e29safety/efficacy, evaluation, e29study drug effects (interpretability), results analysis (impact), e28–e29Dry mouth, malodor and, 523Dual-energy x-ray absorptiometry (DEXA), 223value, 223, 224.e1EE series resolvins, 161Early human gingivitis lesion, 246fEarly implant designs/materials, limitations, 705–711Early lesion, 92, 93fEarly-onset aggressive periodontitis, cause, 173Early-onset diseases, aggressiveness, 63–64Early-onset periodontitis, 147EBDM, Evidence-based decision makingEbers papyrus, eiEBM, Evidence-based medicineEBV, Epstein Barr VirusEcchymosis, evidence of, 213fEchovirus, 135tEcologic plaque hypothesis, 138–139periodontal diseases (relationship), 138fEdematous tissue, 588Edentulism4815 prevalence, 476.e5ttransition from terminal dentition to, 783.e2, 783.e3fEdentulous arch, design, 741Edentulous areasclinical photographs, 748fperiapical radiograph, high-resolution detailed image, 754fEdentulous edges, mucogingival deformities/conditions, 65bEdentulous mandible, 783.e4Edentulous maxilla, 783.e1–783.e4MSCT examination of, 758fEdentulous molar maxillary area, radiograph of, 595fEdentulous patients, 741–742, 752.e1b, 752.e1fEdentulous posterior left mandible, radiographic evaluation, 764fEdentulous ridgesdefects, clinical image, 78fmucogingival deformities/conditions, 77Edentulous right/left treatment areas, 707fEdentulous spacecontinuous pack, 603fevaluation of, CBCT for, 756f–757fEDRs, Electronic dental recordsEhlers-Danlos syndrome, 173, 175b, 350Eicosapentaenoic acid (EPA), 160–161Eikenella corrodens, 445, 468Eisenmenger syndrome, 224.e2ELAM-1, Endothelial leukocyte adhesion molecule-1Elastic connective tissue fiber, 27Electrocoagulation, 606Electrolytic imbalances, 476.e34816 Electronic cigarettes, 185bElectronic dental records (EDRs), e1–e6benefits of, e4challenges, e4communication/collaboration, limited functionality, e4data representation/interoperability, e4functionalities/components, e1future, e5learning curve, steepness, e4potential, realization (challenges), e4reliability, insufficiency, e4reuse, research purposes, e4suboptimal usability, e4usage, e1–e5barriers, e5Electronic nose, 528.e1Electronic periodontal probing, 388.e1Electronic stimulatory devices, 583.e20–583.e21Electrosection, 606Electrosurgery, 606Electrotomy, 606Elevation, 786–788, 792ELISA, Enzyme-linked immunosorbent assayEMBASE, 5Embrasure spaces, 518EMD, Enamel matrix derivativeEmergence profile, 779–780Emergency equipment, 600Emerging host modulatory therapies, 573.e1Enamel epithelium, reduction, 254817 Enamel formation, completion, 27Enamel matrix derivative (EMD), usage of, 647–648, 649bEnamel matrix proteins, 567ENAP, Excisional new attachment procedureEndocarditis, infective, 445–447Endocrine disorders, 208–212, 283–284, 447–450Endocrine system, e59Endodontic infection, 487.e1treatment (absence), 503Endodontic lesions, periodontitis (association), 74–75, 75bEndodontic pathosis, on development of retrograde peri-implantitis, 505.e1Endodontic procedural complications, periodontium, 498Endodontic-periodontal lesions, 74–75, e48b–e49b, e110, e110fEndodontic/periodontal prognosis, 583.e7Endodontic-periodontic lesions, 498–505case scenario, 505.e5b, 505.e5fclassification of, 499ftreatment considerations of, 505.e3–505.e4Endodontic therapy, 505.e2Endolysosomal membrane, 153Endosseous implant, positioning, 712fEndosteum, 44Endothelial cells, 152tEndothelial leukocyte adhesion molecule-1 (ELAM-1), 231Endotoxins, 94reservoir of, 230Endpointcross-classification, two-by-two table (usage), 14t4818 definition, modification, 12–13End-tidal carbon dioxide, monitoring, 435–436English surgeon's knot, 687.e4, 687.e4fEnlargementacute inflammatory enlargement, 257chronic inflammatory, 258conditioned, 262developmental, 265, 266fdrug-induced gingival, 256, 260–261false, 265idiopathic gingival, 265inflammatory enlargement, 257–259Entamoeba gingivalis, 136Enterovirus, 135tEnzyme-linked immunosorbent assay (ELISA), for HIV, 365.e3–365.e4Eosinophils, 28EPA, Eicosapentaenoic acidEpidemiologic studies, 15–16designs, 84–85impact, 81single, 16busage, 15bEpidemiology, WHO definition of, 80Epidermal blisters, occurrence, 296Epidermolysis bullosa acquisita, 289tEpigallocatechin, 530Epigenetics, 168t–169tEpilepsy patient, gingival enlargement, e64fEpisodic-burst model, 3484819 Epithelial attachment (EA)apical edge, 735histologic scheme of, 738fEpithelial cells, 152tof mucosa, HIV and, 365.e2stimulation, 565.e1Epithelial desquamation areas, 308Epithelial downgrowth, 738fEpithelial intercellular spaces, scanning electron micrograph, 116fEpithelial migration, impeding, 645.e4Epithelial restsdistribution, 35of Malassez, 35, 35fEpithelial surfacescanning electron microscopic view, 25fsloughing, clinical images, 60fEpithelial tissues, 104–105, 105tEpithelium, 735Epoxygenases, 160Epstein Barr virus (EBV), 134t–135t, 133.e1impact, 367Epulis, 266Equigingival margins, 699Erbium:yttrium-aluminum-garnet laser, 689t, 691.e1–691.e2Er,Cr:YAG laser, 691.e2Erectile dysfunction (ED), periodontal disease in, 233Erosive lesions (ulcerative lesions), 291Erosive lichen planus, 291tappearance, 292f4820 desquamation/spontaneous bleeding, e72fdesquamative gingivitis, presentation, 292fError rates, types, 13Erupting tooth, junctional epithelium (formation), 26fEruption cyst, 277appearance, 278fEruption gingivitis, 281Erythema multiforme, 301–302appearance, 301fduration, 301histopathology, 301immunofluorescence, 301treatment, 301–302Erythematous candidiasis (presence), 366Escharotic drugs, 490–491Esophageal-type cytokeratins, 25.e1Essential hypertension (primary hypertension), occurrence, 442–443Essential oil mouthrinses, 520.e3Essential oils, 529Essex provisional, delivery, 823.e3Established lesion, 92–93Estrogen deficiency, 224.e1–224.e2Estrogen receptor (ESR1), 175Ethical principles, impact, 17Etidronate (Didronel), 221tEubacterium nodatum, 142Eustachius, Bartholomeus, eiiEvaluation of evidence, 227tEvidence, 1b4821 acquisition, 7appraisal, 7–8assessment, tools, 10–18consumer, becoming, 3–6critical thinking, 10–18levels, 5t, 6search, 7suppression, 18Evidence-based clinical practice, 226–228Evidence-based decision making (EBDM), 1–9, 8b, 574–575background/definition, 1clinical application, case scenario, 4bdiagram, 2fpathway, 4fprinciples, 1–2process, application skills/abilities, 2bskills, 2–8tool, value, 8Evidence-based dentistry, 1busage, 8Evidence-based medicine (EBM), 1b, 724Evidence-based sources, types, 5Exacerbation period, 311–312Excessive gingival display, therapy, 663.e20–663.e23, 663.e22fExcisional instruments, 605–606Excisional new attachment procedure (ENAP), 645.e4, 615.e1Excursion, 576evaluation, 579Excursive movement, 576Exfoliative cheilitis, 369.e2fExogenous cortisone, adverse effect of, 2244822 Exon, 168t–169tExostoses, 321, 321f, 595, 646.e1Expanded polytetrafluoroethylene (ePTFE) barrier membrane, 796f,795.e1fremoval, 813Experimental gingivitis, human biopsy sample, 244f–245fExperimental occlusal traumadog, 331frat, 330fExploratory stroke, 545.e7, 545.e7bExplorers, 531–532, 532btypes, 532finsertion, 532fExposurecross-classification, two-by-two table (usage), 14tdefinition, modification, 12randomization, absence, 15Exposure-based study designs., 85Extended-shank curettes, 536–537, 537b, 537fExtended-shank Gracey curettes, 536–537, 545.e10, 545.e10bExternal bevel incisions, 610External connection implant, 770, 772fExternal insulin, impact, e90fExternal oblique ridge, 591External viewer, 842–844, 844fExtracellular DNA (eDNA), 95–96Extracellular enzymes, 131Extracted lower molar (distal root), subgingival calculus (dark-pigmented deposits), 121f4823 Extractionalveolar ridge preservation/management, 802–803delayed implant placement for, 802–803immediate implant placement for, 803, 804fstaged implant placement, 803microsurgical, 680fsite, implant drilling, 824–825, 825fExtraoral bruising, clinical photograph, 849fExtraoral fulcrums, 545.e4–545.e5, 545.e5bExtraoral halitosis, 521–522Extraoral palm-down fulcrum, 545.e5fExtraoral palm-up fulcrum, 545.e5fExtraoral preoperative condition, 705fExtraoral sites, bone from, 646.e1–646.e2Extraoral structures, examination of, 381–382Extraradicular infection, interactions of, 505.e1–505.e2Eyeglass-mounted prism loupes, 684fEZcodes, e4FFaceSturge-Weber syndrome, unilateral cavernous hemangiomas, e77fswelling, complaints, e97fFacets, 390Facial asymmetry, e76fFacial bone, lipping, 322fFacial bony contours, tooth position (effects), 638fFacial connective tissue graft, 826fFacial gingival surface, gingival abscess on, 258f4824 Facial interdental papillae, 21fFacial lesions, radiographs, 401fFacial pocket, gutta-percha points (placement), 405fFactitious lesions, 302.e1Factitious traumatic lesions, e79Fair prognosis, 413False gingival enlargement, 265Familial aggregation and relative risk, 171tFat-soluble vitamin deficiency, 220.e1Fauchard, Pierre, eiiiFavorable prognosis, 413FDBA, Freeze-dried bone allograftFDPs, Fixed dental prosthesisFEA, Finite element analysisFeedback, in real-time micro positioning implant surgery, 842Female reproductive cycle, 466fFemale sex hormones, 212Femoral artery bypass, 445Fenestration, 45defects, 797, 799fdehiscence, 46fFentanyl, combined with midazolam, 439.e6Ferric sulfate, misuse, e80fFetor ex ore (term), 382, 521Fetor hepaticus, 523.e1Fetor oris, 382Fiber bundles, cuff-like circular orientation, 735Fiberoptic endoscope, 542–543, 543f4825 Fibers, 30apical fibers, 34circular fibers, 28gingivodental fibers, 27–28groups, diagram, 34fhorizontal fibers, 34interradicular fibers, 34oblique fibers, 34principal fibers, 33transseptal fibers, 34, 34fFibrils, 34f, 149Fibrin, in L-PRF, 668, 669fFibrin sealers, to platelet concentrates, 664Fibrinogen (FBG), 175Fibroblasts, 256Fibroma, e83fFibronectin, 645.e4Fibroosseous integration, 733.e1Fibrosarcoma, 267Fibrosis, 256Fibrotic pocket walls, 308–309Fibrous dysplasia, unilateral fibroosseous expansion, e76fField of view (FOV), 755, 755bFilaggrin, 22.e1File scalers, 531, 533fFiles, 541, 541b, 541fdiamond-coated, 542Fimbriae, 95Final crowns, 710f4826 Final implant site preparation, precision (enhancement), 789bFinger flexing, 545.e7Finger on finger rest, 545.e4, 545.e4fFinger rest, 545.e3–545.e4, 545.e4bFingers, developmental deformities, e74fFinite element analysis (FEA), 733.e7First incision, 619First lower molar, mesial root (recession), 662fFirst molar tooth replacement, diagnostic models, 746.e1fFirst molarsadvanced alveolar bone resorption, clinical/cone-beam computed tomography,e95fangular bone loss, furcation (involvement), 400ffurcation involvement, 403fhuman head, frontal section, 597fradiographic evaluation, 764freplacement failure of, 335–336First premolar, canine/fenestration (dehiscence), 46fFistula, impact, 853fFistula tract, clinical images, 76fFixed-bone-anchored bridge, 741Fixed dental prosthesis (FDPs), 770Fixed macrophages, 28Fixed partial dentures (FPDs), 847Fixed prosthodontic tooth replacement, 783.e1Flap closure, 641.e4for one-stage implant placement, 793for two-stage implant placement, 789Flap operation, 6314827 Flap surgical technique, 631pocket depth reduction/elimination technique, 618Flapless approach, implant placement, complications related to,856.e3–856.e5, 856.e4f–856.e5fFlapless dental implant microsurgery, 825fFlapsapically displaced flap, 620–621, 631classification, 614coaptation, 614design, 613f, 622, 786–788, 792displaced flaps, 614elevation, 613–614examples, 614ffull-thickness flap, 613internal bevel incisions, locations, 619fmanagement of, 794–795nondisplaced flaps, 614partial-thickness flap, 613partial-thickness repositioned flap, 790–792, 791fplacement, 641.e4surgeryhealing, 622–626incisions, usage, 619fusage, 616–618, 631Flat-bladed gingivectomy knives, 545.e29, 545.e29fFlattening interproximal bone, 641.e2–641.e3Florida Probe, 390.e1Flossing, 865fcontraindication, 285–286facilitation, 517Fluoridecaries-preventive effect of, 514, 520.e2usage, 4784828 Flushing of the periodontal pocket, 520.e2Focal infection, eviFocal infection theory, 226, 226b“Foci of infection”, 89Folic acid deficiency, 220.e1–220.e2Follicle-stimulating hormone (FSH), production, 466Follicular phase, 466Food, accumulation of, 522Food and Drug Administration (FDA) registration, clinical trials,e27Food impaction, 198, 322Forced eruption, 583.e6–583.e8Foreign bodygingivitis, 302.e1impaction, proliferative gingival overgrowth, 62freactions, 61Formyl peptide receptor (FPR1), 175Four-unit FPDs, 855fFOV, Field of viewFPDs, Fixed partial denturesFractionation, 206Fractureextension, mesiodistal orientation, 711fimplant, 856, 856flevel, 583.e7of restorative materials, 856, 857fscrew loosening and, 856Fractured central incisor, X-ray, 825fFractured porcelain, 857f4829 Fractured root, extrusion, 583.e7fFractured teeth, 583.e6–583.e8Fragmented sleep, hypnogram, 458fFrameshift mutation, 168t–169tFree connective tissue autografts, 663.e6, 663.e6b, 663.e7f, 663.e9Free gingival autograft, 663.e8–663.e9Free gingival grafts, 662f, 663.e1, 663.e1f, 663.e2b, 663.e3f, 663.e5fFree gingival groove, 19Free gingival margin, 702fFreeze-dried bone allograft (FDBA), 646demineralized, 646use of, 795Frenectomy/frenotomy, 662f, 663.e17, 663.e18fFrontal process, 593FSH, Follicle-stimulating hormoneFull-arch FPDs, 854fFull-mouth disinfection, 486Full-mouth series, periapical/bite-wing radiographs, 399fFull-thickness flap, 613, 614b, 626periosteal, release, 823.e2f–823.e3fraising, 786–788Functional antagonist teeth, loss, e54fFunctional imbalance, 329Functional occlusal relationships, 393Fungi, 136Furcationadvanced defects of, 657anatomy of, 654areas4830 access, 419Nabers probe, usage, 532fclass III furcation involvement, 659fdental implants, 658early defects, 656–657entrance, narrowness, 422fetiologic factors of, 653, 659.e1bhemisection, 658.e2, 658.e5fdimension, 658.e3finterradicular dimension, 658.e3finvasion, 390.e1–390.e3lesions, considerations, 583.e4nonaggressive techniques for, 657nonsurgical therapy, 657, 657boral hygiene procedures, 657Perio-Aid, utilization, 658fprognosis, 658–659regeneration, 658root resection, 658.e1–658.e2scaling and root planing, 657surgical therapy, 658treatment, 656–657, 656bFurcation defects, 583.e4–583.e6, 583.e5bdiagnosis/classification of, 653therapeutic classes, 656–657two-walled/three-walled components, 658Furcation involvement, 324f, 325–327, 326f–327f, 403, 655fdegrees, radiographs of, 654f, 656bdental findings, 655example, 403ffirst molar, 403fGlickman's classification of, 656fgrade III cervical enamel projections, 655findication, triangular radiolucency (usage), 403f4831 indices of, 655–656mandibular first/second molars, 403fprognosis/treatment, anatomic features, 654fFusariosis, 137tFusobacterium nucleatum, 71growth, 114f–115flevels, elevation, 465prevalence, 363Fusospirochetal complex, 273bGGABA, Gamma-aminobutyric acidβ-galactosidase tests, 528.e1Gamma-aminobutyric acid (GABA), 467GAP, Generalized aggressive periodontitisGas chromatography, 526–527machinery, 526fOralChroma portable, 526fGastroesophageal reflux disease (GERD), 463susceptibility, 467GBR, Guided bone regenerationGCF, Gingival crevicular fluidGelatinous microbic plaque, eivGEM 21S, 567, 649Gene, 168t–169tGene association reports, 176tGene association tests, cases/P values, 175fGene expression, 168t–169tGene-mapping strategy, 1704832 General anesthesia, 434ADA guidelines, 432ADA policy statement, 432definition, 433fpatient preference, 432fGeneralized aggressive periodontitis (GAP), 147, 353, 358appearance, 354f–355fclinical/radiographic views, e96fcrown-to-root ratio, problems, 420fdiagnostic criteria, 353tGeneralized bone lossin chronic periodontitis, e86f–e87fradiographic, e85fGeneralized calculus deposit, 280fGeneralized chronic periodontitis, 346clinical features of, 343fGeneralized diffuse gingivitis, 248appearance, 249fGeneralized horizontal bone loss, 400fGeneralized human papilloma virus-associated warts, e84fGeneralized marginal gingivitis, 248appearance, 249fGeneralized papillary gingivitis, appearance, 249fGeneralized periodontitis, host modulation (usage), 571Generalized severe chronic periodontitis, 416fGenetic association study, case-control design, 172fGenetic code, 168t–169tGenetic disorders, 218, e99Genetic drift, 167Genetic epidemiology, 1674833 Genetic factors, 418importance, 141Genetic heterogeneity, 170Genetic marker, 170Genetic syndromes, periodontitis in, 173Genome, 168t–169tGenome-wide association studies (GWAS), 167, 171tGenomic methods, 170Genotype, 168t–169tfrequencies, 172Genuine halitosis, 521classification of, 522fGeotrichosis, 137tGERD, Gastroesophageal reflux diseaseGeriatric dentistry, 476.e2Geriatric dentists, 476.e2Geriatricians, 476.e1–476.e2Germ theory of disease, eivGermany, periodontitis (prevalence) in, 348fGerontogenes, 475Getting long in the tooth, expression, 53GG genotype, 179Giant cell fibroma, 266, 266fGiant cell granuloma, peripheral, e84fGingipains, 94, 149Gingiva, 19–32, 90–91, 90f, 91baccidental damage, 61advanced chronic periodontitis, e51f4834 allergic response, 62fanatomic landmarks, 20fapparent/actual positions, diagram, 254fappearance (adult), 20fappearance (child), 278fattached, 20, 386f, 389–390mean width, 20fbiopsy, 32fblood supply, 29–30, 29fbuccolingual section of, 737fcalcified masses, 252clinical appearance, 30fclinical features, 19–21microscopic features, correlation, 30–32color, 30–31changes, 251–252consistency, 31changes, 252–253clinical/histopathologic changes, 253tcontour, 31, 384adjunctive procedure, 490defense mechanisms of, 237–242demarcation in, e49fdestruction, mucormycosis infection (impact), e68fdiscoloration, metal particles (impact), 252fenlarged, inflammatory components, 629benlargement of, 256histologic slide, 739finterdental area, 19interdental col, anatomic variations, 21finterdental gingiva, 20–21keratinization, decrease, e77fkeratinized gingiva, scanning electron micrograph, 23flesions, acute streptococcal gingivostomatitis (impact), e65flymphatic drainage, 294835 lymphatics, 29–30marginal area, 19medication, impact, 251melanotic pigmentation, 30fmetallic pigmentation, 252microscopic examination, 244microscopic features, 21–30clinical features, correlation, 30–32mucositis, e67fnerves, 29–30opportunistic bacterial infection, 217fpassive eruption, diagrammatic representation, 33fpemphigus vulgaris, 297fperiodic localized color changes, e60fperipheral circulation, 29fpigmentation, apicoectomy/amalgam retrofill (impact), 62fplaque accumulation, e51fposition, 32, 254–255changes, 253–255recession, 384–385, 386frecontouring, 616red color of, e51fscanning electron microscopic view, 30fshape, 31shelflike contour, 31fsize, 31spontaneous bleeding, decrease, e77fstaining, periodic acid-Schiff histochemical method (usage), 24fstippling ofappearance, e50floss of, e50fsurface texture, 31–32changes, 253surgery, 615suture needle penetration, 687.e2f4836 swelling, complaints, e97fswollen/spongy gingiva, leukemia (primary medical diagnosis), 58ftoothache, plant seed placement, e82ftoothbrushing, impact, 253traumatic lesions, 253–254visual examination of, 383–385, 385b, 385twidth of, 383–384Gingival abscess, 258, 258f, 493, 497, 628periodontal abscess and, 390.e3Gingival augmentationapical to recession, 663.e1–663.e7, 663.e2fcoronal to recession, 663.e7–663.e17, 663.e8b, 663.e8fGingival bleedingacute episodes, 251chronic bleeding, 250–251hemorrhagic disorders, 251increase, 467blocal factors, 250–251medications (relationship), 250bpresence of, 381probingappearance, 250fusage, 249–250recurrent bleeding, 250–251severity, factors, 251spontaneous bleeding, 251systemic changes, impact, 251variation, 249Gingival cauterization, eiifGingival connective tissue, 27–30aging, impact, 52repair, 28–29Gingival contour4837 changes, 255irregularity, 246fGingival crevice, tactile examination of, 387–390, 387bGingival crevicular fluid (GCF), 91, 105, 193, 310bamount, 238analysis of, 239cellular elements of, 239, 242bcellular/humoral activity in, 239chlorhexidine, release, e7circadian periodicity, 239clinical significance of, 239, 239bcollagenasepresence, 568–569SDD (effect), 571fcomposition of, 238–239diagnostic tests of, 238tdrugs in, 239–240electrolytes in, presence of, 239flow, increase, 186–187levels of, 235.e3measurement, electronic device, 238fmechanical stimulation of, 239organic compounds of, 239periodontal therapy, 239PGE2 levels, 469presence of, 237sex hormones, 239smoking and, 239total protein content of, 239Gingival curettage, 615.e1Gingival cysts, 267Gingival desquamation, cologne, impact, e81fGingival discrepancies, orthodontic treatment, 583.e9–583.e114838 Gingival diseases, 55–61, 57batlas of, e48b–e49bbacterial origin, 59–60dental-plaque-induced gingival diseases, 55–59drug-induced, e64fungal origin, 60–61, e67, e67f–e68fgenetic origin, 61malnutrition, impact, 423modificationmalnutrition, impact, 59medications, impact, 58–59systemic factors, impact, 58non-plaque-induced, e48b–e49b, e65–e67plaque-induced, e48b–e49b, e49–e51prognosis, 422–423systemic factors, impact, e59viral origin, 60Gingival disturbances, blood dyscrasias (association), 213Gingival embrasurescorrection, 703.e1, 703.e1fwith gingival recession, management of, 703.e1–703.e2volume, papillary form (relationship), 703fGingival enlargement, 256–267, 422, 267.e1b–267.e2b, 267.e1f–267.e2facute lymphocytic leukemia, e98fantibiotics administration, 629bcyclosporine and, e64fdrug-associated gingival enlargement, 628–631false, 265flap surgery, 631bforms of, 265–267inflammatory, 257–259involvement, impact, 260fjuvenile hyaline fibromatosis, e74fmicroscopic view of, 261f4839 in mouth breather, 258fphenytoin therapy in, impact of, 261fpregnancy and, e60f–e61frecurrence, 632–635substitute drug, prescribing, 629btreatment, 628–635, 635.e1b–635.e2b, 635.e1f–635.e2ftypes of, 257–265with vitamin C deficiency, 263, 264fGingival epithelium, 21–27, 91bbiology, 21–24cell type, 22compartment, 21–22features, 22bfunction, 22, 22bkeratinization, decrease, 50oral aspect, 23frenewal, 27structural/metabolic characteristics, 24thinning, 50variations, 24fGingival erythematous candidiasis, 366fGingival fibers, 27–28faciolingual section, 28fGingival fibroblasts, 152tGingival fibromatosis, 265, 265bGingival fluid (sulcular fluid), 27Gingival form, factors, 583.e9Gingival hemorrhage, 216Gingival hyperplasia, 256acute myelogenous leukemia and, e62fGingival Index (GI), 82, 390.e14840 Gingival inflammation, 60f, 243–247, 384, 386farea, 317fbiologic width, 254bviolation, impact, e79fextension, impact, 316–320histopathologic alterations, impact, 250impact, 128, e59f, e80fmouth breathing, 251bpathways of, 318fplaque accumulation, impact of, 586fpresence, 29fsign, 121fspontaneous bleeding, e63fGingival innervation, 30Gingival lesionsgenetic origin, e69lichen planus, 291non-plaque-induced, 59–61pregnancy, 635Gingival margincrown/root surface, relationship (diagram), 51fdiscrepancy, 583.e9position, variation, 51fscanning electron micrograph, 23funeven, 583.e9–583.e10Gingival massage, 518b, 519–520Gingival mucous membrane pemphigoid, appearance, 295fGingival necrosis, e107fGingival overgrowth (GO), 256associated with systemic conditions, 262–265calcium channel blocker, usage (clinical images), 59fdiagnosis of, 2574841 heart transplant/cyclosporine therapy (impact), 59fleukemia-associated, 264nutrition-associated, 263–264pregnancy-associated, 262–263proliferation, 62fpuberty-associated, 263Gingival papillomas, 266, 266fGingival pigmentation, causes, 252Gingival pockets, 303therapy for, 588Gingival recession, 52b, 254–255, 661b, e81faggressive horizontal brushing, 61bappearance, 279f, e102fatrophy, 32clinical photograph, 850fclinical significance, 255factors in, 662bhabitual cleansing, e82finadequacy, e75fincreases, 254nail scratching, e82folder persons, 476.e5fseverity, 254thalassemia and, e63fGingival responses, etiology, 470bGingival retraction, ferric sulfate during, misuse of, e80fGingival sulcular depth, 277Gingival sulcus, 19–20, 303bdevelopment, 26epithelial surface, scanning electron microscopic view, 25fepon-embedded human biopsy specimen, 25fformation, 264842 keratinocytes, exfoliation, 23fprobing depth, 19–20spontaneous bleeding from, thrombocytopenia and, 214fGingival surgery, 583.e8Gingival thickening, steroid injections and, e65fGingival third, provisional restoration, 708fGingival tissues, edematous characteristics, 466–467Gingival trauma, ligature wire, impact, e81fGingival wall, microtopography, 307–308Gingival width, insufficiency, e74fGingivectomy, 615, 630–631, 630badvantages, 630healing, 616indications/contraindications, 615performing, 631periodontal knives, 605, 606ftechnique, 615usage, 631fGingivitis, 143t, 145–146, 224.e4f, 220.e2advanced, 243, 247fanatomic/histologic changes, 29bacterial etiology, experimental proof, 126fcategorization, 243chronic, 248chronic periodontitis versus, 346clinical features, 248–255, e49, 255.e1b–255.e2b, 255.e1f–255.e2fevaluation, systematic approach, 249clinical findings, 249–255color changes, 251–252course/duration, 248dental plaque, association, 422description, 2484843 desquamative, 287–302, 302.e2b, 302.e2fdiagnosis, 56bdiffuse gingivitis, 248early human gingivitis lesion, 246fearly stage, 243established stage, 243establishment, 246fexperimental, human biopsy sample, 244f–245fhallmark, 248bhistopathology of, 91–94, 92b, 93fHIV-associated gingivitis, 60–61initial stage, 243marginal gingivitis, 248occurrence, 248papillary gingivitis, 248pregnancy-associated gingivitis, 146prevention of, 724, 724bprogression, 247recurrent gingivitis, 248smoking, effects, 182, 182tstages, 244ttreatment of, 724, 724bGingivodental fibers, 27–28diagram, 28fGingivoplasty, 616performing, 631Gingivostomatitis, streptococcal, e65fGlanzmann thrombasthenia, impact, e63fGleevec, usage, 376Glickman, Irving, eviifGlobal Medical Device Nomenclature, 841GLT6D1, 3514844 aggressive periodontitis (association), 177Glucocorticosteroid, 450.e1–450.e2, 450.e1tGlutathione S-transferase mu 1 (GSTM1), 175responsibility, 175Glycated hemoglobin (Hb) assay, 448bGlycemic controlperiodontal infection with, 234–235periodontal therapy on, 234problem, chronic gram-negative periodontal infections, 235Glycogen, intracellular accumulation, 24.e1Glycosyltransferase (GLT6D1) gene, 175GO, Gingival overgrowthGold alloy abutments, 778Gold alloy crown, 197fGold alloy prostheses, 865Gold-colored abutments, 778–779, 779fGoldman-Fox scissors, 607fGood prognosis, 413Gottlieb, Bernhard, evGPCRs, G-protein coupled receptorsG-protein coupled receptors (GPCRs), 161–162Gracey curettes, 534–536, 534f, 535b, 536f, 545.e8–545.e11additions, 536After Five curette, 537–539, 537fcomparison, 537fblade, 545.e6f, 545.e9comparison, 538fdesign, 537fprinciples of use, 545.e9–545.e10, 545.e9f–545.e10f, 545.e10bset, reduction, 535f4845 shank availability, 536universal curettes, differences, 535Gracey Curvette blade, 538–539, 538f–539fGrade I furcation involvement, 655Grade II furcation involvement, 655, 657fGrade III furcation involvement, 655–656Grade III furcation lesion, 658.e2fGrade IV furcation involvement, 656Graft-associated reconstructive procedures, 646–647Graft bed suture, diagram of, 663.e2fGrafted site, stability, 663Graftsallografts, 645autogenous bone, 645–646autografts, 645bone allografts, 646, 646bmaterial and procedures, 645–646xenografts, 645–646Graft-versus-host diseaseappearance, 302.e1foccurrence, 302.e1Granular layer, 24fGranulation tissue, removal, 620Granulocytopenia, 213WBC count, reduction, 216Gray-colored metallic abutments, 778–779Greater palatine foramen, 593Grooved acrylic stent, 642.e4fGrooving, 538–5394846 Ground substance, 27, 35–36Growth factors, 567in L-PRF, 668, 669fin vitro effects, 651tG-specific granules, 23GSTM1, Glutathione S-transferase mu 1GTR, Guided tissue regenerationGuarded prognosis, 728–729Guidance, 576Guided bone regeneration (GBR), 707f, 794.e2–794.e4autogenous bone for, 794.e3–794.e4barrier membranes for, 794.e2–794.e3biologic requirements for, 794.e2tbone graft materials for, 794.e3complications related to, 856.e1, 856.e1fsupracrestal/vertical bone augmentation and, 813–815, 814fGuided tissue regeneration (GTR), 645, 645.e4b, 794.e2, 645.e1f–645.e2ffor root coverage, 663.e14–663.e15, 663.e15fGuided tissue regeneration membrane/titanium-reinforced (GTRM-TR) membrane, 814fGum, chewing, 528Gutta-percha points, 148fas abutment screw cover, 780.e1placement, 405fGWAS, Genome-wide association studiesHHAART, Highly active antiretroviral therapyHabits, considerations, 7514847 Hader bar, with clip, 783.e4fHaim-Munk syndrome, 173, 350Haligram, 526fHalimeter, 525, 525fversus OralChroma, 527bHalitophobia, 523–524Halitosis, 382categories of, 521course of, 524bextraoral causes of, 523Hand movement, microsurgery and, 677fHaplotype, 168t–169tHard tissue replacement (HTR) polymer, 647.e1Hard tissuesbacteria (adherence), 116destruction, mucormycosis causing, e67fevaluation, 746–749, 748fhealing, Piezosurgery and, 833, 833binterface, 733–735schematic illustration of, 736fHarmonious muscle function, 338.e1HAV, Hepatitis A virusHayflick's limit, 475HBV, Hepatitis B virushCMV, Human cytomegalovirusHCV, Hepatitis C virusHDV, Hepatitis D virusHeadache disorders (neurovascular disorders), 339bHeadache pain, perception, 3394848 Healing, 508–509abutment, occlusal view, 745fgingival changes, 490success and failure rates of, 505Health history, 378–381, 379f–380fimportance of, 378Heart transplant, impact, 59fHebrews, eiHematologic disorders, 213–218, 284–285Hematoma, 848–849, 849fHemidesmosomes, impact, 25Hemisection, 658.e2, 658.e5fdimension, 658.e3fprocedure, 658.e2–658.e5Hemiseptal defects, 583.e1–583.e3Hemophilia A, 450patient, plaque accumulation/spontaneous bleeding, e63fHemophilia B, 450Hemorrhage, 848–849, 849b, 849fexcessive, 601Hemorrhagic disorders, 450–453, 451tHemostasis, 600–602absorbable hemostatic agents, 601tHeparin, 452Hepatitis, 456.e2–456.e3, 456.e2tHepatitis A virus (HAV), 456.e2Hepatitis B virus (HBV), 456.e2Hepatitis C virus (HCV), 456.e3Hepatitis D virus (HDV), 456.e34849 Hepatitis G virus (HGV), 456.e3Hereditary gingival fibromatosis, 61, e69intraoral view, e69f, e71ftuberosities, enlargement, e70fHeredity, 168t–169tHeritability, 167–169calculation, 178–179Herpes simplex virus (HSV), primary infection, 491bHerpes simplex virus-1, 134t–135telectron micrographic picture, 133fHerpes simplex virus-2, 134t–135tHerpesvirus infection, e66, e66fHerpesviruses, 133.e1recovery, 134t–135tHerpetic gingivostomatitis, ruptured/unruptured herpetic vesicles,e66fHerpetic lesionsabnormality, 370ftreatment, penciclovir (usage), 376Herpetic whitlow, 491Hertwig epithelial root sheath, role, 46Heterosexual transmission, HIV and, 365.e2Heterozygous, 168t–169tHETEs, Hydroxyeicosatetraenoic acidsHGV, Hepatitis G virusHighly active antiretroviral therapy (HAART), 365.e5–365.e6adverse drug effects, 369.e2usage, 376High-molecular-weight mucinous glycoproteins, 2414850 High-risk patients (smokers), 569High-sensitivity C-reactive protein (hsCRP) concentration,biochemical bone turnover markets (relationship), 571.e1Hippocrates, eiHirschfeld, Isadore, eviHistoplasmosis, 137tHIV, Human immunodeficiency virusHIV-1, 136tHIV-2, 136tHLAs, Human leukocyte antigensHMT, Host modulationHoe scalers, 531, 533f, 540–541design, 541fusage, 540–541Home irrigation, impact of, 520.e2Homologous fibrin sealers, 664Homozygous, 168t–169tHopeless prognosis, 413Hopeless teethextraction, 697maintenance, 583.e8–583.e9Horizontal bone augmentation, 795–797ePTFE barrier membrane, expansion, 796f, 795.e1fmonocortical block graft for, 795–797, 797b, 798fparticulate bone graft for, 795, 795.e1f–795.e2fHorizontal bone loss, 322, 322fmandibular implants, impact, 855fHorizontal fibers, 34Horizontal incisions, 609–6124851 Horizontal mattress suture, 614.e2Hormonal changes, 208–212, 283–284Hormonal contraceptives, 212.e2Hormone-exaggerated marginal/papillary inflammation, 58fHormone replacement therapy, evidence, 17Horny layer, 24fHospital-acquired bacterial pneumonia, 235.e4Host defense, 172–173Host-derived inflammatory mediators, 96Host-driven inflammatory response, 574Host immune responsedeficiencies in, 213obstruction elements, down-regulation, 566bHost immunity, evasion strategies, 149–150Host-microbe interactions, practical molecular biology of, 151–158Host modulation (HMT), 564–573, 566bcomprehensive periodontal management, relationship, 567–568concept, 564definition, 564destructive cascade, aspects, 573bpurpose, 565.e2–565.e3risk reduction, 565.e3bsystemic disorders, factors, 573.e1–573.e2usage, 565Host proteins (degradation), bacterial enzymes (impact), 130Host response, 172–173Host response modulation, 568Host susceptibility, 141concept of, 107f, 109–1114852 Host tissue cells, invasion, 146Host-tissue-degrading activity, restriction, 149Host vaginal epithelial cells, glucose supply, 116HSV, Herpes simplex virusHuman biologic width, 700fHuman cytomegalovirus (hCMV), 134t–135t, 133.e1Human DFDBA particles, mixture, 797–799Human Genome Project, 167Human herpesvirus-6, 134t–135tHuman herpesvirus-7, 134t–135tHuman herpesvirus-8, 134t–135tidentification, 367Human immunodeficiency virus (HIV), 456.e3age, impact, 365.e2antiretroviral therapy, 365.e4–365.e5, 365.e5bCDC Surveillance Case Classification for, 365.e3–365.e4, 365.e3b, 365.e4fclassification of, 365.e2demographics of, 365.e2–365.e3epidemiology of, 365.e2–365.e3gingivitis associated with, 60–61health status, 372–373herpetic lesions, abnormality, 370finfectioncontrol measures, 373oral/periodontal manifestations, 365–369pathology and management of periodontal problems with, 365–373maintenance therapy, 373necrotizing ulcerative periodontitis and, 362, 362bpathogenesis, 365.e2periodontal treatment protocol, 372–373psychologic factors, 373risk of, 6464853 staging of, 365.e2testing for, 365.e3–365.e4therapy, goals, 373Human leukocyte antigens (HLAs), 170HLA-B, reports/findings, 175–177Humansdisease/nondisease traits, 169–170palate, histologic frontal section of, 593fpapillomaviruses, grouping, 133.e1plaque sample, vertical section, 119ftrauma in, occlusion of, 332Hunter, John, eiiiHunter, William, eviHuntington disease gene mutation, 170Hybrid crown design, 774–777, 777fHydrogen peroxide, 529Hydropic degeneration, 25Hydroxyapatite (HA), 191, 647.e1bisphosphonate affinity for, 221crystals, alignment, 47in implant surface, 733.e3, 733.e3fHydroxyeicosatetraenoic acids (HETEs), 160Hygieneaccess, restoration, 864fneglect, e58fplaque accumulation and gingivitis due to, e52fHygienic pontic, 703fHyperbaric oxygen (HBO) therapy, 751Hypercapnia, 463.e2bHypercementosis, 394854 cause, variation, 39.e1occurrence, 39.e1Hyperesthesia, 849Hyperglycemia, 209, 212bHyperkeratinization, 220.e1Hyperkeratosis, 70fHypermobility, 510Hyperparathyroidism, 212.e2–212.e3, 212.e2f–212.e3fHyperplasia, 468f, 220.e1steroid injections and, e65fHyperplastic candidiasis, 366, 367fHyperplastic gingivitis, 716fHyperresponsive monocyte/macrophage phenotype,cardiovascular/periodontal consequences, 232fHypersalivation, mandibular repositioning devices and, 463.e1Hypersensitivity, 391dental materials to, 702Hypersomnolence, 459, 463.e2bHypertension, 442–444, 444bamlodipine-associated gingival enlargement, e64fHypertensive patients, dental treatment, 443Hyperthyroidism, 450.e1Hypertrophic gingivitis, 256Hypertrophy, 256Hypnogram, 463.e2bHypoesthesia, 849Hypoglycemia, 449oral agents, 449tsigns and symptoms, 449b4855 Hypophosphatasia, 224.e2–224.e3, e104fHypopnea, 463.e2bHypothyroidism, 450.e1, 463.e2bHypoxia, 463.e2bHypoxic dips, 463.e2bIIatrogenic effects, 476.e10Iatrogenic traumatic lesions, e79Ibandronate (Boniva), 221tICAM-1, Intercellular adhesion molecule-1Idiopathic gingival enlargement, 265, 265fetiology of, 265Iliac autograft, placement of, 646.e2fIllumination, 545.e1–545.e2, 545.e1f–545.e2f, 545.e2bImaginary breath odor, 523–524Imaging modalities, 406–408, 408b, 408f–409fIME, Internal mobile elementImmediate goals, 426Immediate implant occlusion, 827, 827fImmediate implant placement, 803, 804f, 870complications related to, 856.e3Immediate occlusal loading, 870Immune compromise, 363, 751Immune deficiencies, 213–218, 284–285Immune-inflammatory responses, 91, 186Immune reconstitution inflammatory syndrome, 365.e6Immune response4856 aging, impact, 53nutrient effects, 476.e4tnutrition, modulator, 53in periodontal pathogenesis, 103–109Immune suppression, 751Immunity, innate, 159Immunomodulatory therapies, 158Immunosuppressants, 223, 260–262Immunosuppressed patient, opportunistic bacterial infection, 217fImmunosuppression, 455systemic disease, impact, 491Impacted mandibular right second molar, 583.e8fImpaired chewing, 476.e3Implant-abutment connection, 770–774, 771b, 772fclassification, 770, 772fexternal, 770, 772ffistula, 853finternal, 771–772, 772fplatform switched, 772, 773fsolid body, 772f, 773–774, 774ftapered element in, 772Implant-assisted overlay denturefor edentulous mandible, 783.e4, 783.e5ffor edentulous maxilla, 783.e1–783.e2, 783.e2fImplant placement, 707f, 789congenitally missing maxillary lateral incisors, radiographic evaluation, 763fdehiscence defect, observation, 799fdelayed, 802–803versus staged technique for, 800f–801f, 803edentulous posterior left mandible, radiographic evaluation, 764fflapless approach, complications related to, 856.e3–856.e5, 856.e4f–856.e5fimmediate, 803, 804f4857 complications related to, 856.e3implant placement, 870loading after, 856.e3loading protocols, 870maxillary first premolar, extraction, 804fmissing tooth, CBCT examination, 763fone-stage, 792–793Piezosurgery for, 838f–839ffor predictability and aesthetics, 818–819radiographic follow-up, 767fsimultaneous, 797–799, 807, 809f, 807.e1fspace requirement for, 749bstaged, 803surgery, clinical view, 787f, 790fsurgical techniques for, 589timing, 802, 802btwo-stage, 785–792Implant-retained provisional restorations, 782.e1, 782.e1f, 782.e3ffabrication of, 782.e1t, 782.e2fpolymerizing flowable composite in, 782.e3ftemporary abutments and, 782.e1, 782.e2fImplant sitesin anterior aesthetic zone, with extensive bone loss, 818fprecision, enhancement, 789bpreparation, 784–785for one-stage implant placement, 792for one-stage versus two-stage implant placement surgery, 784–785, 785ffor two-staged implant placement, 786f, 788–789, 788b, 788fpreparation, for Piezoelectric bone surgery, 837–839, 837f–839fImplant successclinical example, 868fcriteria, modifications (impact), 869tdefinition, 846–847, 847b, 867, 868brate, outcomes, 869treport on, 8464858 variation, 867Implant surgery, L-PRF and, 671.e3, 671.e4f, 671.e5bImplantable cardioverter-defibrillators, 445Implantsabutmentcolor shift, 780bdesign and emergence profile, 779–780, 779fmaterial selection, 777–779, 778f, 779badditive process of, 733.e3, 733.e3f–733.e4fadjacent, splinting of, 780–781, 780f, 781banatomic location, 869anchorage, 583.e14–583.e15direct, 583.e14f–583.e15f, 583.e19indirect, 583.e15f–583.e16f, 583.e19anticipated load on, implant diameter and, 769–770, 769bblade, 733.e1, 733.e1fbuccal probing, 861fbuccolingual placement, 850clinical comparison of, 739–740complicationsaesthetics, 856–857biologic, 846, 852–856failures and, 846–858, 858.e1bphonetic, 858prosthetic/mechanical, 846, 856related to augmentation procedures, 856.e1–856.e3related to placement and loading protocols, 856.e3–856.e5surgical, 846, 848–852types/prevalence of, 847–848, 848fconsiderations, 769–774custom abutments, 710fcylindrical, 733.e1–733.e2, 733.e1f–733.e2fdental, 658design, 869–870characteristics, 870diagnostic imaging for, 753–768, 768.e1b–768.e2b, 768.e1f–768.e2fclinical selection of, 764–7684859 cross-sectional, 755–757standard projections in, 753–755, 754tdisk, 733.e1distribution, Cantilever length (relationship), 783.e6fexamination, 390–393, 859–862, 860bfailure, 854–856, 855fdetection, radiographic examination (usage), 862radiograph, 855freport, 846flap surgery, muscles, 595fracture, 856internal connection collar location, 856fgeometry, 732–733, 733b, 740.e1bhealing, 712fabutments, 708fimmobility, 733, 734binteractions in orthodontics, 583.e14–583.e21, 583.e14b, 583.e17floss, 854–856macroscopic configuration, 732–733maintenance, 864–865keratinized tissue for, 749bmalposition, 850–852, 850f–851f, 852bmicrodesign, 733.e2–733.e7microsurgery, 824–829, 824bmodern, history of, 732, 732bnumber of, 770, 770focclusion, 827, 827forthodontic site preparation, 583.e15–583.e19osseointegration, evaluation, 863outcomesdefining, 867–869, 870bfactors, 869–871panoramic radiograph, 869fpartially edentulous, management of, 781–782, 782bdiagnosis and treatment planning in, 781–782, 782fimplant-retained provisional restorations for, 782.e1, 782.e1f, 782.e3ftissue shaping and, 7824860 penetration of, 768fpercussion, 862periapical radiograph, 862fpins, 733.e1planning phase, 583.e14–583.e19, 583.e14bplaque/calculus formation, e54fposition, alveolar ridge and, 764, 764f–765fprimary and secondary stability, 734–735probing, 387, 861bprostheticsconsiderations to, 769–783, 783.e7b, 783.e7fmajor/minor complications, 774tprovisional crown, creation, 826restoration, 828–829, 828f–829fevaluation, 864occlusal schemes, 864results, 869space management, 583.e19stability measures, 861staple-bone, 733.e2subcrestal placement, 863fsubperiosteal, 733.e2, 733.e3fsubtractive processes of, 733.e4, 733.e5f–733.e7fsurfacecharacteristics, 733.e2–733.e7chemical composition of, 733.e4–733.e5free energy and microscopic roughness, 733.e6–733.e7surgery, 707f, 784–793, 793.e1badvanced, 806–816, 816.e1b, 816.e1fpatient preparation, 784principles, 784–785, 785bsurvival, 868definition of, 846–847, 847btherapyrisk factors and contraindications for, 749–751, 750tshort-term outcomes/long-term outcomes, smoking (impact), 188transmandibular, 733.e24861 treatmentmultidisciplinary specialist education, trends, 713patient satisfaction, 872tphase, 583.e19plan, 583.e20fresults, 867–872, 872.e1btypes of, 848Implant-support restoration, 713fImplant-supported bridge, usage, 75f, 79fImplant-supported crowns/veneers, posttreatment clinical image,77fImplant-supported fixed prosthesis, 783.e4, 783.e6fImplant-supported fixed restoration, pink porcelain for, 858fImplant-supported FPDs, 847survival/complication rates, 848Impregnation, L-PRF and, 673IMZ implants, 733.e2fInactive pockets, healing of, 586Incidence rates, 81, 82fIncisional instruments, 605–606Incisions, 609–612, 618–619, 786–788, 792crevicular incision, 610–612horizontal incisions, 609–612presurgical view, 623f–625fremote incision, layered suturing technique, 786reverse bevel incision, 610second incision, 610–612vertical incisions, 612, 613fIncisive nerve, anterior extension, 591Inclinable adjustable eyepieces, 686fIncorrect bite size, 687.e2f4862 Incremental dosing, 433–434Independent endo-perio lesion, 505.e4fIndependent sling suture, continuous, 614.e2, 614.e3f–614.e4fIndex finger-reinforced rest, 545.e5fIndia, medical works of ancient, eiIndiana University sickle scaler, 533Indirect anchorage, 583.e15f–583.e16f, 583.e19Individual tooth prognosisdetermination, 414overall prognosis, differences, 414Individualized dentistry, pharmacogenetics and, 179–180Individualized plaque growth pattern, 127fIndividualized treatments, benefits, 180Indole, 528.e1Induction, 439.e3–439.e4L-PRF and, 673Infectionscontrol issues, e4endodontic, 487.e1transmission, prevention (measures), 600Infectious diseases, 456.e2–456.e3Infective endocarditis (IE), 442, 445–447, 446bprevention (AHA publication), 445–446riskperiodontal procedures, 446treduction, preventive measures, 445Inferior alveolar nerveanterior extension of, 591canal, CT scan, 850fInflamed palatal gingiva, 199f4863 Inflammasomes, 155Inflammationactivated, 159acute, final remarks of, 163–165biologic complication, 852, 853fchronic, 160in periodontal diseases, 162–163clinical implications of, 163bdefinition of, 159–160resolution of, 102–103, 159–165, 162b, 165f, 510, 165.e1b, 165.e1fsevere, e88fsigns of, 159vascular supply and, 738–739, 739fInflammatory cytokines, interleukins (ILs), 159–160Inflammatory enlargement, of gingiva due to gingivitis, 257–259chronic, 257f, 259fclinical manifestations of, 257etiology of, 257–258, 257bhistopathology of, 258–259treatment of, 259Inflammatory infiltrate, 317Inflammatory lipid mediators (LMs), 159–160Inflammatory mediators, serum levels, assessment of, 232–233Inflammatory process, 147–148Inflammatory proliferation, impact, 852fInflammatory reactions, WBC involvement, 213Inflammatory responses, 159aging, impact, 53nutrition modulation, 53in periodontium, 94–100, 97bInformed consent, 6004864 elements, e29tlegal considerations, e29Infrared light-emitting diodes (IREDs) markers, 842Infuse, 567Inherited genetic variation, 179fInherited variation/risk, 173Initial bone healing, 733–734, 734b, 734fInitial lesion, 92Innate immune cells, 152Innate immunity, 103–106, 103t, 159Insomnia, 463.e2bInstrument grasp, 545.e3, 545.e3bInstrumentationactivation, 545.e5–545.e8clean field, 545.e2–545.e3condition and sharpness, 545.e2, 545.e2bdetection skills, 545.e13–545.e14, 545.e14bprinciples of, 549–550, 549b, 549f, 545.e1–545.e11, 545.e1bfor scaling and root planing, 545.e8–545.e11sharpening, 545.e23–545.e30, 545.e23bevaluation of, 545.e23–545.e24individual, 545.e25–545.e30, 545.e25f–545.e27fobjective of, 545.e24, 545.e24bprinciples of, 545.e24–545.e25stones, 545.e24, 545.e25fstabilization, 545.e3–545.e5, 545.e3bsupragingival scaling techniques, 545.e14Insulin, 449, 450binsulin-dependent diabetes mellitus, 208–209resistance, 234–235types, 450tIntangible benefits, 3744865 realization/perception, absence, 374tangible benefits, differences, 374–375, 374b–375bInteractive simulation software programs, 757, 759f–761fIntercellular adhesion molecule-1 (ICAM-1), 231Intercellular matrix, cells (relationship), 43Interdental alveolar bone, arteriole penetration (diagram), 29fInterdental bone, 397appearance, 402fcrestappearance, 398ftransseptal fibers, 34fInterdental brushes, 518Interdental cleaning, 528devices, 518–519technique, 519, 519brecommendations for, 518–519Interdental colabsence, 21fanatomic variations, 21fmandibular anterior segment, 21fmandibular posterior segment, 21fInterdental craters, 402–403detection of, 387Interdental denudation procedure, 610Interdental gingiva, 20–21broadness, 277col shape, 20–21facial/lingual surfaces, tapering, 21Interdental gingival papillae, shape (correlation), 31fInterdental knives, 605Interdental lesion, extension, 401f4866 Interdental ligation, 614.e1Interdental mesial/distal lesions, 401fInterdental papillae, 20fabsence, 21fappearance, 31fcrest, 268formation, attached gingiva (impact), 21flocalized gingival swelling, leukemic infiltration, 215fsurvey section, 269fInterdental septum (interdental septa), 44, 45fautopsy section, 319fInterdental spacefor implant placement, 746bmicroscopic view, 250fsuprabony pockets, 314fInterdental tissues, removal, 631Interdisciplinary model of therapy, 705, 705fInterference, 576Interleukin-1 (IL-1), 52, 219family cytokines, 97–99Interleukin-1α (IL-1α), 97, 98tInterleukin-1β (IL-1β), 97, 98t, 469, 833, e34Interleukin-1F7b (IL-1F7b), 98Interleukin-1Ra (IL-1Ra), 97, 98tInterleukin-4 (IL-4), 52Interleukin-6 (IL-6), 99Interleukin-10 (IL-10), 52Interleukin-33 (IL-33), 98, 98tIntermediate cementum, 394867 Intermediate goals, 426Internal basal lamina, 25Internal bevel incision, 610diagram, 610flocations, 619fInternal connection implant, 771–772, 772fInternal mobile element (IME), 733.e2Internal mobile shock absorber, 733.e2, 733.e2fInternational Team for Implantology (ITI) hollow cylinder implant,733.e1, 733.e1fInterocclusal space, requirement, 746bInterproximal bone loss, extent, 639Interproximal cleaning devices, 519fInterproximal craters, 641.e7fInterproximal embrasuresmanagement of, 702–703, 702b, 702fspaces, variation, 518fInterproximal gingiva, overhanging amalgam margin, effects of,509fInterproximal knives, 545.e29, 545.e29f–545.e30fInterproximal papilla, behavior (comparison), 702fInterproximal soft tissue cratering, bone necrosis, 694fInterradicular dimension, 654Interradicular fibers, 34Interrupted figure-eight suture, 614.e2fInterrupted sling suture, single, 614.e2fInterseptal bone (flattening), bitewing radiograph, 278fIntervening col, 20fIntervention trials, 2274868 Intrabony defectsaggressive periodontitis, e94ftreatment of, 645Intrabony periodontal pocketsfeatures, 314tflap, raising, 314foccurrence, 303Intrabony pockets, radiographic/microscopic features, 313fIntracapsular disorder, 339Intracranial pain disorders, 339bIntraepithelial viral vesicles, biopsy, 275fIntraoperative radiographic assessment, 766–768, 766f, 768fIntraoral aphthous stomatitis, AIDS (impact), 371fIntraoral examination, 746–749, 746b, 747fIntraoral habitats, 117tIntraoral hard surfaces, 119Intraoral herpetic vesicles, recurrence, 274fIntraoral nutrients/microorganisms, mechanical reduction, 528Intraoral pain disorders, 339, 339bIntraoral periapical radiographs, implants, 862bIntraoral preoperative condition, 706fIntraoral sites, bone from, 646.e1Intraradicular infection, 505.e1Intraspin centrifuge, 666Intrasulcular incisions, 631Intravenous (IV) conscious sedation, consent form/explanation, 435fIntravenous (IV) sedation, 439.e5combination, 439.e5–439.e6equipment/supplies, 437f–438f4869 Intron, 168t–169tInvasion-associated genes, screen, 150InVivo5 planning software, 757, 760f–761fInvolucrin, 22.e1Ion-exchange resin, 131Iron deficiency anemia, 218.e1gingiva/vascular structures, e62fIron, deposition, 252Irregular proximal tooth surfaces, cleaning, 520fIrrigation, 546–554case scenario, 554.e1bclinical outcomes of, 552, 552b, 553tconsiderations, 552–553, 553f–554fgingival, 520.e2bmechanism of action, 550–552, 550f, 551boral, 520.e1–520.e2, 520.e1fsafety, 551–552, 552bsubgingival, 520.e2supragingival, 520.e1–520.e2technique, 520.e2Ischemic heart disease, 229–230, 444–445, 444fpathways of, 230fIsoform, 168t–169tJJaquette sickle scalers, 533Jawbisphosphonate-related osteonecrosis, 71medication-related osteonecrosis, 71–73titanium implants, placement, 41.e1tooth in situ, 42f4870 visualization, 754fJet tip, 551fJiggling forces, 332Journal of Clinical Periodontology, eviiJournal of Periodontology, eviiJP2 clone strains, occurrence, 358Junctional epithelium, 25–26, 90–91, 91battachment, 25zone, 311changes, detection, 243–244degenerative changes, 305extension, 305features, 307bformation, 26fkeratin polypeptides, 25.e1location, aging (effect), 50–52permeability of, 237–238proliferation, 32removal of, 645.e3–645.e4biomodification of root surface for, 645.e3–645.e4chemical agents for, 645.e3curettage for, 645.e3, 645.e4bsurgical techniques for, 645.e4scanning electronic microscope (SEM) image of, 737fstructure, self-renewal, 26Juvenile hyaline fibromatosis, gingival enlargement, e74fKKaposi sarcoma (KS), 267, 367–368bacillary angiomatosis, mimicry, 369fcutaneous, 367.e3fgingival, 368.e1fhistologic view, 368f4871 intraoral, 367.e4focular, 367.e4fKennedy Classification, 744bclass I/II partially edentulous situations, 742class II distal extension, 743fKeplerian loupes, types, 684Keplerian optical system, 684Keratinization process, 22Keratinized gingivaabsence, 77freestablishment, 78fscanning electron micrograph, 23fKeratinized gingival epithelium, 24fKeratinized mucosa, 738Keratinized tissue, 736–738requirement, 749bKeratinizing metaplasia, 220.e1Keratinocytesexfoliation, 23fflattening, 23fKeratinosomes, 22.e1Keratinsimmunohistochemical expression, 24.e1polypeptides, 25.e1Keratolinin, 22.e1Keratotic lesions, 291Keystone pathogen, 139Kidneyfailure, 443transplant, cyclosporine after, gingival enlargement in, e64f4872 Kindler syndrome, 173, 350Kirkland knife, 606fusage, 615Knife-edge alveolar process, 788Koch, Robert, eivKoecker, Leonard, eiiiKöller, Carl, eiii–eivKostmann syndrome, 350Krause-type end bulbs, 30KS, Kaposi sarcomaLLactic acid, 528.e1Lactoperoxidase-thiocyanate system, 241Lactotransferrin (LTF), 175LAD, Leukocyte adhesion deficiencyLamina duraforamina perforation, 36ffuzziness/disruption, 402prominence, 277Lamina propria, 27LANAP, Laser-assisted new attachment procedureLanger curettes, 539, 540fLangerhans cells, 23LAP, Localized aggressive periodontitisLarger-diameter implants, 769–770Larger tips, 545.e21, 545.e21bLaser-ablated surface, 738f4873 Laser-assisted new attachment procedure (LANAP), 644–645,694.e1, 694.e1f–694.e2fLaser-microtextured surface, 738fLasersapplications, in periodontics, 691–694aesthetic and pre-prosthetic, 691–692nonsurgical, 693–694, 693bbiologic interactions of, 688–691, 689f, 691bcarbon dioxide laser treatment, e52fcase scenario on, 695.e1bCO2, 691.e2components of, 689fdiode, 691.e1, 691.e1fenergy, 688boverexposure, 694–695, 694ferbium:yttrium-aluminum-garnet, 691.e1–691.e2Er,Cr:YAG, 691.e2history, 688naming, 689neodymium:yttrium-aluminum-garnet, 691.e1for peri-implantitis, 694.e2–694.e3, 694.e2ffor periodontitis, 694.e1–694.e2, 694.e1f–694.e2fphysics of, 688–691, 689b, 689ftherapy, complications/risks of, 694–695, 694ftypes of, 689t, 691.e1–691.e2wavelengths, 689–691, 690f–691fLateral cephalometric radiographs, 753, 754tLateral excursion, 576Lateral incisordiagnostic models, photographs, 746.e1fnoninvasive extraction, 825fperiotome extraction, 825fLateral periodontal cyst, 3154874 Lateral pressure, 545.e7, 545.e7bLateral window antrostomy, 812.e1fLateral window sinus lift, complications related to, 856.e1–856.e2,856.e2fLateral window technique, 809–812, 812f, 812.e1fLaterally displaced pedicle flap, 663.e9, 663.e9f–663.e10fLavage, 520.e2Lazy leukocyte syndrome, 218.e2LDD, Low-dose doxycyclineLead intoxication, 224.e3Ledges, 325, 326fLeeuwenhoek, Anton van, eii–eiiiLeft central incisorextrusion, localized aggressive periodontitis (impact), e93fperiodontal abscess, e108fLeft maxillary second premolar, radiographic evaluation, 764fLesionsadvanced lesion, 247early lesion, 244established lesion, 244–247initial lesion, 243–244occlusal view, 401fLeukemia, 214–218, 284, 453, e62, e97acute lymphoblastic leukemia, appearance, 285fclassification of, 214cutis, 214–215existence of, 217–218patients withgingival (bacterial) infection, 216–217periodontium, condition, 214–218primary medical diagnosis, gingival problems, 58f4875 ulcerations, 216fLeukemia-associated gingival overgrowthclinical manifestations of, 264, 264fhistopathology of, 264necrotizing ulcerative inflammatory in, 264Leukemic gingival enlargement, 631–632treatment, SRP usage, 632Leukemic infiltrate, 216fLeukemic infiltration, 214–216Leukocyte adhesion deficiency (LAD), 173, 173f, 218.e2appearance, e100f–e101fLeukocyte-and platelet-rich fibrin (L-PRF), 664–675block, observations on, 673.e1, 673.e1b, 673.e1f–673.e2fcase scenario, 675.e1b, 675.e1fclot, 666extraoral applications of, 668.e1, 668.e2f–668.e3ffibrin in, 668, 669fgrowth factors in, 668, 669fimplant surgery and, 671.e3, 671.e4f, 671.e5bleukocytes in, 667–668, 668b, 668tmacrophages, 668medication-related osteonecrosis of jawbone and, 673.e1membranes, general characteristics of, 667–668neutrophils, 668for periodontal bony defects, 669, 669b–670b, 670f, 671tfor periodontal mucogingival surgery, 671–673, 673b, 674f–675f, 674t, 675bplatelets in, 667, 667bpreparation of, 666, 666b, 666f–667ffor ridge preservation, 670–671, 672b, 672f, 673tsinus floor elevation and, 671.e1, 671.e1f–671.e2f, 671.e2b–671.e3b, 671.e5fstem cells in, 668Leukocyte-bacteria interaction areas, 3084876 Leukocytesconsideration, 28.e1disorders, 213–214emergencearea, 308scanning electron micrograph, 246finfiltration, 305in L-PRF, 667–668, 668tscanning electron microscope, 240ftraversal, scanning electron micrograph, 246fLeukopenia, 214Leukotrienes, 160LGE, Linear gingival erythemaLibellus de Dentibus, eiiLichen planus, 289t, 290b, e71fatrophic, e72fbullous lichen planus, consideration, 297–298differential diagnosis, 292–293direct immunofluorescence, 292f–293ferosive, 291, e72fappearance, 292fgingival lesions, 291immunopathology, 292impact, 288microscopic appearance, 292foral, histopathology, 292boral lesions, 291reticular, e71ftreatment, 290f, 293, 293fLigand, 168t–169tLigature wire, impact, e81fLight amplification by stimulated emission of radiation (laser), 688–6894877 Ligosan slow release, e11, e12fLine-angle inconsistencies (widow's peak), removal, 639Linear gingival erythema (LGE), 60–61, 369–371, 371fcorrective therapy, response problem, 370diagnosis, difficulty, 370precursor, 3704878 Linear immunoglobulin A disease (LAD) (linear immunoglobulin Adermatosis), 289t, 299appearance, 299fdifferential diagnosis, 299histopathology, 299immunofluorescence, 299oral lesions, 299treatment, 299Lingual nerve, 591Lingual set screws, 777Linkage, 168t–169tanalysis, 170, 171tdisequilibrium, 168t–169tLipherpetic vesicles, recurrence, 273flesions, acute streptococcal gingivostomatitis (impact), e65fmucosa, recurrent, e78fLipid mediators, 162fLipopolysaccharide (LPS), 94, 94b, 154, 228, 228bLipoxin A4, 160–161Lipoxins, 102, 161, 162fLipoxygenases (LOs), 160Lister, Joseph, eivListerine antiseptic, ADA approval, 478Liver diseases, 453.e2LJP, Localized juvenile periodontitisLL-37, 101LLLT, Low-level laser therapyLoading protocols, 8704879 Local anatomic factors, 653–655Local anesthesia, 601, eiii–eivLocal delivery agents, SDD, combination, 572Local delivery rationale, e11–e14Localized aggressive periodontitis (LAP), 146–147, 163, 283, 355–356, 405abnormalities, 359appearance, 356f–357fbacteria, presence, 358bone destruction, 405fcharacterization, 405diagnostic criteria, 353tleft central incisor, extrusion, e93fosseous lesion, progression (radiographs), 484fscaling/root planing, 481treatment, tetracyclines (usage), 557Localized bleeding, Glanzmann thrombasthenia (impact), e63fLocalized chronic periodontitis, 346Localized diffuse gingivitis, 248Localized gingival anoxemia, 245Localized gingivitis, 248Localized juvenile periodontitis (LJP), 146, 405prevalence, 356Localized juvenile spongiotic gingival hyperplasia, 282appearance, 283fLocalized marginal gingivitis, 248Localized papillary gingivitis, 248Localized ridge augmentation, 794–802, 805.e1b, 805.e1fcomplications of, 799–802, 799bflap management in, 794–7954880 horizontal bone augmentation in, 795–797simultaneous implant placement, 797–799Localized tooth-related factors, 65b, 75–77Locally administered agents, 566–567Locally delivered controlled-release antimicrobials, e7–e47availability, e31case scenario, e41b–e42b, e42fclinical trials, e15t–e24t, e35t–e38tclinical use, e29–e40, e33fcost-effectiveness, e31costs/outcomes, e31–e34development, e8tdrug development, e14–e29phases, e27drug registration, e14–e29effect, magnitude, e14–e26nonsurgical periodontal therapy, e40fregulatory clearance, e27brelease profile (schematic representation), e13fsafety/efficacy, evaluation, e29Locus, 168t–169tLong-cone paralleling technique, 397bisection-of-the-angle techniques, comparison, 398fLongitudinal studiesdata, 229use of, 227Long-term goal, 426Loose trabecular bone, 789bLorazepam, 439.e1tanxiolytic dosing guidelines for, 439.e2tprecautions and drug interactions, 439.e2bprescription, sample, 439.e4f4881 Loss of attachment, older persons, 476.e6fLoupescompound, 684, 684fKeplerian, 684magnifying, 684–685prism telescopic, 684–685, 684f–685fsimple, 684, 684fsurgical, magnification range, 685Low-birth-weight (LBW) infants, 235.e1periodontitis in, 235.e2Low-dose doxycycline (LDD), 568systemic adjunctive therapy, e30Lower anterior teethcalculus formation, extensive, e80flingual surfaces, bridge-like calculus formation, e55f–e56frestoration, e79fLower central incisoradvanced gingival recession, e74fgingival recession/inflammation, 662fLower first molar, mesial surface, 326fLower front teeth, clinical picture, 147fLower incisor, thin labial bone, 321fLow-level laser therapy (LLLT), 693–694L-PRF, Leukocyte-and platelet-rich fibrinLPS, LipopolysaccharideLTF, LactotransferrinLudwig's angina, 597–598, 598bLupus erythematosus, 300–301oral cavity, 300fsubacute cutaneous lupus erythematosus, 3014882 systemic lupus erythematosus, 300Luteinizing hormone (LH), production, 466Luxated teeth, replantation, 3fLymphatics, 29–30, 49Lymphocyte antigen 96, 94Lymphocytic leukemia, 214Lymphosarcoma, 267Lymphotoxin-alpha (LTA), role of, 175Lys-gingipains, 149Lysozyme, linkage cleaving, 241Lys-Xaa peptide bonds, 149MMacrodesign, 732–733, 733bMacroglossia, mandibular repositioning devices and, 463.e1Macrolides, 560–561clinical use, 560–561pharmacology, 560Macrophage phenotype, 231–232Macrophages, 152t, 565.e2in L-PRF, 668Macrosurgical unsatisfactory outcome, microsurgical correction,682fMagnesium phosphate (Mg3[PO4]2), 191Magnesium whitlockite, 191Magnetic tracking systems, 842Magnetostrictive ultrasonic devices, 546, 547fMagnification systems, 684–6854883 Magnifying loupes, 684–685Maiman, Theodore H., 688Maintenance phase, 427Maintenance program, 715–719, 716bcompliance with, 715fexamination/evaluation in, 716, 716f–720f, 716trecurrence of periodontal disease in, 719, 720ttreatment in, 719Malignant melanoma, 267appearance, e85fMalnutrition, impact, 423Malocclusion, 199–200, 200f, 329, e52advanced, e76fimpact, e55fperiodontal status, relationship, 279severe, e99fwith thalassemia, e63fMalodorous compounds, solubility of, 530Malposition, implant, 850–852, 850f–851f, 852bMAMPs, Microbe-associated molecular patternsMandible, 590–592, 598.e1b–598.e2b, 598.e1f–598.e2falveolar portion of, 591alveolar process, 41body, medial side of, 592centric relation, bimanual manipulation, 578fedentulous, 783.e4facial surface view of, 591flingual aspect, 596flingual surface view, 590flingual view of, 592fnutrient canals, 401f4884 occlusal view, 592fposterior view of, 597framus/molars, occlusal view of, 592fMandibular anterior implants, radiographs, 851fMandibular anterior sextant, 545.e19, 545.e19f–545.e20fMandibular anterior teeth, alignment, 582Mandibular basal bone, mineralization, 47Mandibular canal, 590implant penetration into, 768fMandibular first molarbone destruction, 421ffurcation involvement, 403froot concavities, 421fMandibular implants, bone loss, 855fMandibular incisorsextraction, 823.e2–823.e3implants, diagram, 743fsplinted porcelain-fused-to-metal crowns, overhanging margins (presence),823.e2f–823.e3fMandibular left posterior quadrant, teeth (absence), 583.e6fMandibular left primary canine, gingival recession, 279fMandibular left second molar, class III furcation defect, 583.e5fMandibular left second premolar, absence, 583.e2fMandibular left third molar, class III furcation defect, 583.e6fMandibular molars, 622angular bone loss, 400fmesiodistal section, 42fMandibular overdenture, retention of, attachments for, 783.e5fMandibular premolar, resting state (diagram), 37fMandibular repositioning devices (MRDs), 459, 463, 463.e2b4885 adjustable protrusion, 463.e1characteristics, 462tdental evaluation, 463.e3dentist, usage, 461device design and compliance, 463.e1–463.e3, 463.e1tdurability and ease of cleaning, 463.e1fitting, 463.e3freedom of lateral movement, 463.e1hypersalivation, 463.e1jaw relationship, 463.e2–463.e3macroglossia, 463.e1microglossia, 463.e1occlusal relationship, 463.e2optimal protrusion, 463.e3, 463.e3foral devices, 461–463orthodontic effects, 463.e1–463.e2selection, 463.e1tside effects, 463.e1–463.e2taxonomy, 462ftemporomandibular joint ache, 463.e2tooth pain, 463.e2vertical opening, 463.e1xerostomia, 463.e1Mandibular retromolar tissue, 622Mandibular ridges, tuberosity enlargement (contact), e70fMandibular right caninelocalized periodontal abscess, 494fplaque-associated gingival abscess, 494fMandibular right first molarperiodontal pocket, 583.e2fperiodontally hopeless condition, 583.e8fMandibular right posterior sextant, 545.e20, 545.e20fMandibular right second molar, impaction, 583.e8f4886 Mandibular second molarfurcation involvement, 403fincision designs, 625fpocket eradication, 625fMandibular teeth, absence of, 335fMandibular tori, clinical photograph, 596fManometer, 463.e2bManual toothbrushes, 512fMaresins, 162, 162fMarginal alveolar bone, shape, 332fMarginal bleeding, 386Marginal bone, gradualizing, 641.e3Marginal fit, 701Marginal gingiva (MG), 19, 384, 385ffaciolingual section, 28fmicroscopic appearance of, 215sloughing, ulcerative gingivitis, 73fstippling, absence, 31tactile examination of, 385–386, 386fMarginal gingivitis, 246f, 248contour, 246fMarginal inflammation, 56fMarginal ridge, defect, overeruption, 583.e3fMarginal supragingival plaque/gingivitis, 246fMarginal tissue recession, cause of, 661–662, 661b, 662fMarginsinadequacy, e79fplacement, 699–700, 700b, 700fclinical procedures in, 701.e1–701.e3, 701.e2f–701.e3fguidelines, 7014887 Marrow spaces, resorption, 318Masticator space, 597Masticatory mucosa, 19Masticatory systembiomechanics of, 338.e1clinical examination, 340diagnostic decision making, 340–341discomfort in, 339dysfunction and deterioration, 339evaluation, 340imaging, 340muscles and nerves of, 337otolaryngologic symptoms with, 339.e2patient history and interview, 340questions, examples, 340bMateria alba, 119, 195Maternal immunoresponse, 469Matrix metalloproteinases (MMPs), 93f, 96, 97b, 97t, 99–100, 100t,175, 305b, 163.e1collagen degradation, relationship, 244inhibition, 568–569inhibitors, 568Matrix metalloproteinase-1 (MMP-1), 99Matrix metalloproteinase-8 (MMP-8), 99Matrix metalloproteinase-9 (MMP-9), 99, 219Matrix, organic constituents, 119Maxilla, 592–594acrylic provisional fixed full-arch prosthesis, clinical photograph, 742falveolar process, 41body of, 593edentulous, 783.e1–783.e44888 occlusal view of, 593fpalatal surface of, 223fMaxillary anterior fixed restoration, clinical photograph, 871fMaxillary anterior implant, clinical photograph, 851fMaxillary anterior sextant, 545.e17, 545.e17f–545.e18fMaxillary anterior teethgingiva, periodic localized color changes, e60fperiodontally compromised maxillary anterior teeth, clinical photograph, 821f–822fMaxillary anterior teeth, abrasion, 583.e10fMaxillary canine, region, localized gingival recession, 279Maxillary central incisorscervical root resorption, computed tomography scanning, 76flabial migration of, 334flabial push, 336fposition, implant placement, 799fMaxillary central incisors, interproximal contact, 583.e11Maxillary cuspid, radiograph, 405fMaxillary denture, clinical photograph of, 742fMaxillary first molardistobuccal root resection, diagrams of, 658.e4finterproximal gingiva, overhanging amalgam margin, 509fperiodontal abscess, e108froots concavities, 421ftilt/extrusion, 335fMaxillary first premolar, extraction of, implant placement after, 804fMaxillary implant-retained prosthesis, 783.e1Maxillary incisors, porcelain fused to metal crowns, usage, 79fMaxillary lateral incisors, extraction of, staged/delayed implantplacement for, 800f–801f4889 Maxillary left first molar, periodontal abscess, 495fMaxillary left posterior sextant, 545.e18–545.e19, 545.e18f–545.e19fMaxillary molars, 622buccal surfaces, supragingival calculus, 121fradiograph of, 595fMaxillary overdenture bar, laboratory view, 743fMaxillary premolar space, clinical photograph, 747fMaxillary right canineattached gingiva, fistula (observation), 494fchronic periodontal abscess, 497fMaxillary right central incisorfracture severity, 583.e7fovereruption, 583.e9fMaxillary right first molarsattached gingiva, 495fmesial tipping, significance, 582.e2fovereruption, 583.e3fprobing defect, 583.e1fMaxillary right posterior sextant, 545.e16f–545.e17f, 545.e17Maxillary right second molars, mesial tipping, 582.e2fMaxillary second molardistal defect, sagittal view, 622fmesial-palatal surface (inflammation), 57fosseous defect, coronal view, 621fMaxillary sinus, 593access, lateral window procedure, 812f, 815f–816faugmentation, 813bblood supply, origin of, 594, 594felevation, 806–813contraindications and indications, 806–807, 807bpresurgical evaluation for, 807, 808fsimultaneous implant placement for, 807, 809f, 807.e1f4890 surgical procedures for, 807–813, 807binferior wall of, 594innervation, 594flocation and anatomy of, 594f–595fpneumatization of, 806, 806bMaxillary tuberosity, 593Maximum intercuspation, 576teeth, clinical mark, 578fMaximum recommended dose, 433, 433bMcCall festoons, 255term, usage, 255Mean attachment level, change in, 726fMeasurement distortion, 755Mechanical complications, 846, 856Mechanical debridement, 715Mechanical determinants, 140Mechanical tracking systems, 842Mechanical treatment, antibacterial effect, e11Medical devices, classification of, 841Medical health-related issues, 749–751Medical history, 745–746review (older adults), 476.e8Medical nutrition therapy (MNT), 476.e2Medical Subject Heading (MeSH) databaseterm headings, 87–88usage, 7Medication-related osteonecrosis of the jaw (MRONJ), 71–73American Association of Oral and Maxillofacial Surgeons definition, 71–72lesions, asymptomatic characteristics, 72–73lower premolar/molar, lingual aspect (bone exposure), 73f4891 Medications, 453–456implants and, 750–751prescription, 220–224usage, review (older adults), 476.e8–476.e9Medium to medium-high power setting, 547Meissner-type tactile corpuscles, 30Melaninphysiologic pigmentation, 30–31pigmentation, e51downregulation, ascorbic acid (impact), 30impact, e51fMelanocytes, 23presence, 23fMelanoma, malignant, e85fMenopause, 474.e1–474.e2, 212.e2clinical management, 474.e1–474.e2oral changes, 474.e1Menses, 466–467follicular phase, 466luteal phase, 466management, 467periodontal manifestations, 466–467Menstruation, 212.e1Mental conditions, 751Mental foramen, 590Mental nerve, emergence of, 590b, 591fMental space, 597Mentalis space, location, 597Mercury intoxication, 224.e3Merkel cells, 23–244892 Mesial-distal space, minimum amount of, 747fMesial lesions, radiograph, 401fMesial root resection, advanced bone loss, 658.e6fMesioposterior surfaces, New Gracey curette design, 537fMeta-analyses (MAs), 5–6Metabolic interactions, schematic illustration, 130fMetal fragments, biopsy, 62fMetal instruments, 865Metal intoxication, 224.e3Metal salt solutions, 529–530Metalloceramic crown, 744fMetalloproteinases (TIMPs), inhibitors, 565.e2Methylamine, 528.e1Metronidazole, 485b, 559clinical use, 559effectiveness, 559efficacy, 559pharmacology, 559side effects, 559Mevalonate pathway, 222fMG, Marginal gingivaMicro Mini Five Gracey curettes, 538b, 538fblade description, 538Microarousals, 463.e2bMicrobe-associated molecular patterns (MAMPs), 94, 151–153, 151b,152tMicrobial biofilm growth, occurrence of, 511Microbial flora, 363, 363bMicrobial growth, surfaces (growth), 1174893 Microbial homeostasis, 138disruption, pathogens (impact), 139Microbial invasion, 94–95, 95b, 95fMicrobial plaque biofilm control, 511, 511bMicrobial testing, 861Microbial tooth deposits, periodontal disease risk factor, 410–411Microbial virulence factors, 94–96Microbiologic plaque sampling, 561–563Microdesign, 733.e2–733.e7Microfibrillar collagen hemostat, 602Microfibrils, 34fMicroflora, intervention studies, 52–53Microglossia, mandibular repositioning devices and, 463.e1Microorganisms, mechanical reduction, 528Micro-osteoperforation, 583.e20Micropipettes, use of, 237Microprecision, 831, 832fMicroscope, surgical, 685, 686fMicrosurgical crown-lengthening procedure, 683fatraumatic microsurgical tissue manipulation during, 681fMicrosurgical field, illumination of, 685Microsurgical sutures, 685–687, 687fMicrosurgical tooth extraction, 824, 825fMicrosuturing, of palatal donor, 687.e1fMicrotopography, 733.e2–733.e3Microvasculature permeability (increase), progesterone(association), 466Midazolam4894 meperidine combined with, 439.e6technique, 439.e5Mild chronic periodontitis, 347Mild linear gingival erythema, 371fMild sedationequipment, requirement, 436tpatient pretreatment instructions, 436brecord sample, 440fMilled custom abutments, 780Millipore filters, use of, 645Mineralized dental plaque, 192–193Mini-bladed curettes, 537–539Mini-bladed Gracey curettes, 543, 545.e10f–545.e11f, 545.e11,545.e11bMini Five curette, 537b, 538fAfter Five curette, 537fMini-Langer curettes, 539Minimal sedation, 432and anxiolysis, 439.e1–439.e4with oral medications, guidelines for, 439.e1–439.e3, 439.e2tMinimally invasive approach, 817–823, 818b, 818f, 823.e7b, 823.e7fMinocycline, 559hydrochloride microspheres (Arestin), e9fmicrospheres (Arestin), e8–e10adjunctive administration, microbiologic effects, e32f, e34frelease profile, e14Missing maxillary right central incisor, implant (panoramicradiograph), 869fMissing teethCBCT examination, 763fpartially edentulous maxilla, panoramic view, 765f4895 replacement, 771fMixed apnea, 459Mixed erythematous/hyperplastic candidiasis, 367fMixed erythematous/pseudomembranous candidiasis, 366fMixed infection, periodontitis (consideration), 140Miyazaki tongue coating index, 528fMMP-1, Matrix metalloproteinase-1MMP-8, Matrix metalloproteinase-8MMP-9, Matrix metalloproteinase-9MMPs, Matrix metalloproteinasesMNT, Medical nutrition therapyModerate chronic periodontitis, 347Moderate intravenous (IV) sedation, equipment/supplies, 437f–438fModerate-length root trunks, 638Moderate sedation, 434b, 436b, 438b, 439.e4–439.e6, 439.e5bequipment, requirement, 436toral, 439.e4–439.e5, 439.e5tModerate-to-severe periodontitisanterior sector, therapy, 588–589posterior area, therapy, 589Modern dentistry, eiiiModern medicine, eiii–eivModified pen grasp, 545.e3, 545.e3fModified ridge-lap pontic, 703f,Modified Widman flap, 589, 618–619description, 618technique, 618fMolarsbone, exposure, 73f4896 implants, diagram, 743fmaxillary area, radiograph of, 595froots, boneless window, 45fMolar-sized single crown, support, 856fMonkeyfaciolingual section, 21fperiodontium, vascular supply, 48fMonoclonal antibodies, involvement, 28.e1Monocortical block graft, 795–797, 797b, 798fMonocytes, 152tin L-PRF, 668Monocytic leukemia, 214Monogenic diseases, 69bMononuclear cells, identification of, 240Monozygotic twins, 168t–169tMontana Jack sickle scaler, 533Morning sickness, 469Morphologic defects, surgical techniques for, 589Mortality, periodontal disease and, 228Mounted rotary stones, 545.e24Mouthbreathing, 282, e52gingival changes, 258gingival enlargement, 258fcare, 605hyperplastic candidiasis, 367frinsing, 528Movement arousals, 463.e2bMRDs, Mandibular repositioning devicesMRONJ, Medication-related osteonecrosis of the jaw4897 MSCs, Multipotential stromal cellsMSCT, Multislice computed tomographyMucocutaneous lesions, e71Mucogingival defect, recession (impact), 77fMucogingival deformities/conditionsedentulous edges, 65bteeth, 65bMucogingival line (junction), 20, 663Mucogingival problems, 279management of, 698.e1, 698.e1fMucogingival surgerymuscle attachments, 596fperiodontal, L-PRF for, 671–673, 673b, 674f–675f, 674t, 675brationale, 660term, introduction, 660Mucogingival techniques, selection (criteria), 663Mucormycosis, 137t, e67f–e68fMucositis, 206gingiva, e67fperi-implant, 859treatment of, 865, 866bMucous membrane blisters, occurrence, 296Mucous membrane pemphigoid (cicatricial pemphigoid), 294–296,294bappearance, 294fdifferential diagnosis, 295direct immunofluorescence, 295fhistopathology, 295immunofluorescence, 295ocular lesions, 294oral lesions, 2954898 treatment, 295–296Multidisciplinary specialist education, trends, 713Multidisciplinary treatment, 705, 711fMultinuclear osteoclast, presence, 41fMultiplane device, in 3D projection screen, 844Multiple teeth, 742–744, 743fMultiple-burst model, 348Multipotential stromal cells (MSCs), 651.e1Multislice computed tomography (MSCT), 754t, 755–757, 758fMuscle palpation, 339.e2, 340.e1Muscle spasm, 339.e2Muscles, 595Mutation, 168t–169tMyalgia, 339.e2MyD88- dependent downstream activation, 153–154Myelogenous, definition of, 214Myeloperoxidase (MPO), 175, 241Mylohyoid muscle, 592Mylohyoid ridge, 592Myocardial infarction (MI), 227, 442chronic periodontitis (association), two-by-two table (usage), 15tischemic heart disease category, 445periodontal disease, role on, 231–233Myositis, 339.e2Myospasm, 339.e2Nn-3 polyunsaturated fatty acids (n-3 PUFAs), 573.e14899 Nabers probe, usage, 532fNabors probe, 654fN-acetyltransferase 2 (NAT2), 175Nanolenses, in 3D projection screens, 844Narcolepsy, 463.e2bNarcotics, 505.e4Narrow crest, case scenario, 839.e5b, 839.e5fNarrow-diameter implants, 747f, 770Nasal cavities, viral infection, 524.e1–524.e2National Institute of Dental Research probe, 82Navigation, in real-time micro positioning implant surgery, 841–842, 843fNDA, New Drug ApplicationNd:YAG, Neodymium:yttrium-aluminum-garnetNecessary cause, 85Neck, Sturge-Weber syndrome, unilateral cavernous hemangiomas,e77fNecrotizing gingivitis, lower front teeth (clinical picture), 147fNecrotizing periodontal diseases, 56b, 73–74, 147, 424, e48b–e49b,e104–e106Necrotizing ulcerative gingivitis (NUG), 73, 268–273, 268b, 371, ev,220.e1appearance, 269fbacteria, role, 271chronic desquamative gingivitis, differentiation, 270tchronic periodontal disease, differentiation, 270tclinical course, 269clinical features, 268communicability, 273crater like lesions, e105f4900 debilitating disease, 272diagnosis, 270differential diagnosis, 270–271epidemiology, 272–273etiology, 271–272extension, 361extraoral/systemic signs/symptoms, 268histopathology, 269history, 268host response, role, 272incidence, increase, 371infection, e106flesionsbacteria, relationship, 269bacterial smear, 270b, 270fpseudomembrane, removal, e105flocal predisposing factors, 272nutritional deficiency, 272occurrence, epidemic-like outbreaks, 273oral signs, 268oral symptoms, 268prevalence, 272–273primary herpetic gingivostomatitis, differentiation, 270tpsychosomatic factors, 272punched-out appearance, e104fsmoking, relationship, 272syphilis (secondary stage), differentiation, 271tsystemic predisposing factors, 272treatment, metronidazole, usage, 271Necrotizing ulcerative periodontitis (NUP), 73–74, 361–364, 371, 487appearance, 362f, 371fcase scenario, 364.e1b, 364.e1fclinical attachment, severity, 74fclinical features, 361, 361bearly, AIDS (presence), 372f4901 etiology, 362–364HIV/AIDSabsence, 372fpatients, 362, 362bimmunocompromised status, 363infection, e106fmalnutrition, 364, 364bmicrobial flora, 363microscopic findings, 361–362psychologic stress, 363–364term, adoption, 361therapy, 371Necrotizing ulcerative stomatitis, 362HIV and, 366, 371.e1, 371.e1fNeedle anatomy, 687fNeedleholders, 607, 608fNegative architecture, 638Negative evidence, 18Neisseria gonorrhoeae (gonorrhea), 59–60Neodymium:yttrium-aluminum-garnet (Nd:YAG)laser, 689t, 691.e1use of, 645Neoplastic enlargement of gingival tissues, 256Neoplastic formations in gingival tissues, 265–266Nerve injury, 794.e4Nerves, 29–30Neumann, Robert, eviNeurofibromatosis (von Recklinghausen disease), 252, 212.e2Neurogenic pain disorders, 339bNeurosensory disturbances, 849–850, 850f4902 Neurovascular disorders, Headache disordersNeutral polysaccharides, presence (histochemical evidence), 25Neutropenia, 213treatment, e99ftypes of, 173Neutrophils, 92–93, 152tcollection, 186deficiencies, 213–214disorders, 285function, 105–106impairment, 71impact, 159in L-PRF, 668polymorphonuclear leukocyte, 565.e1Nevi curved posterior sickle scale, 533New bone formation, 734New Drug Application (NDA), e27Next-generation DNA sequencing tools, 172NF-κB, pharmacologic inhibitors of, 158NHL, Non-Hodgkin lymphomaNiacin deficiency, 220.e1Nickel allergy, gingival inflammation, 61fNicotine, 187Nicotine replacement therapy (NRT), 185b, 478.e1Nifedipine, 259Nifedipine-induced gingival enlargement, cyclosporine-inducedgingival enlargement combination (treatment), 633fNikolsky sign, 287b, e71fNinhydrin method, 528.e1Nippers, 6074903 Nitrogen-containing bisphosphonates, potency, 221Nitroglycerin lingual spray formulations, popularity, 445NLRP3-inflammasome complex, 155NNRTIs, Non-nucleoside reverse transcriptase inhibitorsNNT, Number needed to treatNocebo effects, 17–18NOD1-peptidoglycan recognition, 153f, 155, 155bNOD2-peptidoglycan recognition, 153f, 155, 155bNOD-like receptors, in periodontitis, role of, 155–156Nonaminobisphosphonate medications, therapeutic uses, 221tNon-biofilm-induced gingival lesions, appearance, 423Nondisplaced flaps, 614Noneugenol dressing, 602Non-graft-associated reconstructive procedures, 644–645Non-Hodgkin lymphoma (NHL), 368, 368fNoninsulin-dependent diabetes mellitus, 209control (problems), 468fNonkeratinized gingival epithelium, 24fNonkeratinized stratified squamous epithelium, covering, 21fNonmalignant WBCs, 214Non-nucleoside reverse transcriptase inhibitors (NNRTIs), 365.e5Non-plaque-induced gingival lesions, 59–61, 282, e48b–e49b, e65–e67Nonrandomized evidence, reliance (reasons), 17Nonreasonable membranes, 645.e1Nonresorbable barrier membranes, 794.e2–794.e3Nonselective beta-adrenergic receptor antagonists (β-blockers), 444tNonselective beta blockers, 443–4444904 Nonspecific oral ulcerations, Atypical ulcersNonspecific plaque hypothesis, 137–138, 137b, eivNonsteroidal antiinflammatory drugs (NSAIDs), 452–453, 565–566Nonsubmerged implant placement, One-stage implant placementNonsurgical periodontal therapy, 693–694, 693bNonsurgical phase, 427Nonsurgical sculpting, periimplant soft tissue, 709fNonsurgical therapy, 589Nonsyndromic aggressive and chronic periodontitis, 173–177Nonsyndromic periodontitis, 173–174Nonthrombocytopenic purpuras, 453.e1Nonvital teeth, 419Nonworking side, 576Normative values, 87Noxious products, 94NRT, Nicotine replacement therapyNRTIs, Nucleoside reverse transcriptase inhibitorsNSAIDs, Nonsteroidal antiinflammatory drugsNuclear factor-κB (RANK)/RANK ligand(RANKL)/osteoprotegerin, receptor activator of, 102, 102bNucleoside reverse transcriptase inhibitors (NRTIs), 365.e5Nucleotide, 168t–169tNucleotide-binding oligomerization domain-like receptors, 155–156NUG, Necrotizing ulcerative gingivitisNull hypothesis, 170Number needed to treat (NNT), 375NUP, Necrotizing ulcerative periodontitis4905 Nutrient canals, 401fNutrient effects, immune response, 476.e4tNutrition, 476.e2periodontal disease and, 86Nutritional determinant, 140Nutritional influences, 219–220Nutrition-associated gingival growth, 263–264clinical manifestations of, 263etiology of, 263histopathology of, 263–264treatment of, 264OOblique fibers, 34Obstructed breathing, dental clinical signs/symptoms, 458Obstructive apnea, central apnea (differences), 459fObstructive sleep apnea (OSA), 463.e2bcomplementary therapies, 460fdiagnosis, 459–460, 459fgeneral dental practitioner, 463oral devices, 460–461otolaryngology or oromaxillofacial surgery, 460patient communication, 463prevalence, 459primary care physician communication, 462sleep disturbance, absence, 457treatment options, 460–461Occlusal adjustment, 579Occlusal analysis, 340.e1Occlusal appliance therapy, 579, 580f–581f4906 Occlusal disharmony, 329Occlusal dystrophy, 329Occlusal evaluation/therapyclinical examination, 577–579parafunction, 576–577pathogenesis, 574, 581.e1b, 581.e1fterminology, 575–576Occlusal forces, 575fadaptive capacity to, 328, 328b, 336.e1bdirection, stress patterns, 329feffects of, 331impact, resistance, 36increase, tissue response stages, 330–331stage I (injury), 330stage II (repair), 330stage III (periodontium, adaptive remodeling), 331Occlusal function/dysfunction, 576Occlusal interferences/discrepancies, 576Occlusal loading, 870Occlusal radiographs, 753–754, 754tOcclusal stability, 579–581, 579bOcclusal surfaces, calculus coverage, e54fOcclusal therapy, 579–581Occlusal trauma, 65b, 77, 328, 574bOcclusionclinical evaluation of, 577mutilation of, 335fperiodontal pack interference, 603f–604fprimary trauma, 329–330secondary trauma, 329–330trauma, 320, 321b4907 Ochsenbein chisels, pairing of, 607fOctacalcium phosphate, 191Odds, 81Odds ratiocross-products ratio, 14single epidemiologic studies, 16bsize, range, 14–15Odontoclasts, 35Odorchair-side test, 528.e1dark-field/phase-contrast microscopy, 527electronic noise, 528.e1gas chromatography, 526–527oral microbial load, chemical reduction of, 528–529power, 524.e1, 524.e1tsaliva incubation test, 528.e1scores, 524.e1tOffset blade, 534f, 535, 545.e9, 545.e9bOffset osteotomes, 808.e1fOHL, Oral hairy leukoplakiaOlder adultsassessment of risk, 476.e9–476.e10barriers to care, 476.e7caries status, 476.e6case scenario, 478.e2b, 478.e2fdemographics, 476.e1–476.e7, 476.e1fdental assessment, 476.e8–476.e10dental examination, 476.e9bdental interview, 476.e8bdental visits, 476.e6–476.e7dentate status, 476.e4–476.e5extraoral examinations, 476.e94908 frail, 476.e1functional categories, 476.e2tfunctional status, 476.e2, 476.e4bfunctionally dependent, 476.e1health status, 476.e1–476.e2intraoral examinations, 476.e9loss of attachment, 476.e6fmedical assessment, 476.e8–476.e10medication use, review, 476.e8–476.e9nutritional status, 476.e2–476.e3periodontal diseases, 476–477antiplaque agents, 477–478chemotherapeutic agents, 477–478etiology, 476systemic disease, relationship, 476–477periodontal health (maintenance), 477periodontal status, 476.e5–476.e6periodontal treatment, 475–478pocket depths, 476.e6fpopulation distribution, 476.e1, 476.e1bpsychosocial factors, 476.e3–476.e4quality of life, 476.e10therapeutic drug category, 476.e8tO'Leary Index, 520.e5Olfactory response, 524.e1Oligogenic inheritance, 170One-sided chewing, e52calculus formation, e57fplaque formation, e53fOne-stage implant placement, 792–793flap closure and suturing for, 793flap design, incisions, and elevation for, 792, 792fimplant site preparation for, 792postoperative care for, 7934909 two-stage implant placement versus, 784–785, 785fOne-wall angular defects, 636reduction, 641.e7fOne-walled hemiseptal defects, 641.e4requirements, 641.e4–641.e9ONJ, Osteonecrosis of the jawOnline Mendelian Inheritance, 173Opaque titanium temporary abutment, 827fOpen-bite, 392Open-bite neglect, e58fOpen flap access surgery, usage, 188Open flap debridement, L-PRF use during, 670b, 670fOpen gingival embrasures, 583.e10–583.e11orthodontic alignment, impact, 583.e11fOpen growth system, 112–113Open-loop systems, e4–e5Open mouth posture, 282Opportunistic bacterial infection, 217fOpportunistic data, 13Opposite-arch finger rest, 545.e4, 545.e4fOptical tracking systems, 842Oracea, 566Oral bacterial flora, eii–eiiiOral biofilms, architecture of, 121fOral candidiasis, 366–367antifungal therapeutic agents for, 367.e2bleukemia and, 453Oral cavity4910 archaea, 137candidal infection, acute myelogenous leukemia, e67fcolonization, 112, 113fecosystems, 113examination, 382, 488herpesviruses, recovery, 134t–135tlupus erythematosus, 300fmelanin pigmentation, prominence, 30microbial perspective, 112–117, 113b, 116bnonbacterial inhabitants, 133–137, 133bpapillomaviruses, recovery, 134t–135tpemphigus vulgaris, 296fpicornaviruses, recovery, 135tprotozoa, presence, 136–137retroviruses, recovery, 136tviruses, 133–136yeasts, presence, 136Oral contraceptives (OCs), 473–474management, 473–474Oral diseases, biofilm (importance), 119Oral environment, cementum (exposure), 41Oral examination, performing, 746Oral hairy leukoplakia (OHL), 367tongue, 367.e3fleft lateral border, 368fOral halitosis, complaints (presence/absence), 522Oral Health in America, 564Oral health, saliva role in, 240tOral hygiene, eicomplication, e74fgingivitis and, 724impact, 698f4911 instruction, provision, 446measures, 697methods, 865fprocedures, 657neglect (prolongation), plaque formation/periodontitis, e53fprogram, 520.e6regimen, 381Oral hyperpigmentation, 368–369incidence, increase, 368–369Oral implants, introduction, 129Oral irrigation, 520.e1–520.e2, 520.e1ftechnique, 520.e2Oral lesionsbullous pemphigoid, 293–294chronic ulcerative stomatitis, 298–299healing, penciclovir (association), 14tin HIV, 365–366lichen planus, 291linear immunoglobulin A disease (linear immunoglobulin A dermatosis), 299pemphigus vulgaris, 296Oral leukoplakia, 206fOral malodorchronic, 528dark-field/phase-contrast microscopy, 527treatment of, 528–530Oral microbial loadamine fluoride/stannous fluoride, 529baking soda, 529chemical reduction of, 528–529chlorhexidine, 529chlorine dioxide, 529essential oils, 529hydrogen peroxide, 5294912 oxidizing lozenges, 529triclosan, 529two-phase oil-water rinse, 529Oral mucosa, 19facial/palatal surfaces, 31fOral mucous membrane pemphigoid, microscopic features, 295fOral (outer) epithelium, 24Oral pathologies, 133Oral pemphigus, direct immunofluorescence, 297fOral repigmentation, 30–31Oral sedation, 439.e1–439.e3and inhalation sedation. combination of, 439.e5and intravenous sedation, combination of, 439.e6Oral spirochetes, eii–iiiOral tumors, 133Oral ulcers, 133Oral viral diseasesclinical manifestations, 133–136oral pathologies, 133oral tumors, 133oral ulcers, 133periodontitis, 135–136Oral yeast infections, etiologic agents, 137tOralChroma, graphic from, 527fOrban, Balint J., evfOrban interdental knife, 606fusage, 631Organic constituents, 119Organic matrix, 42Organoleptic rating, 524–525, 525f4913 Orofacial pain, 339–340development, 458, 339.e1differential diagnosis, 339bin muscles of mastication, 339.e2Oropharyngeal examination, 527Orthodontic anchorage, hopeless teeth (maintenance), 583.e8–583.e9, 583.e9bOrthodontic appliancesgingival changes, 281Orthodontic appliances, size, reduction, 582Orthodontic correction, indication, 662Orthodontic therapy, 200bfor adult, 201bbenefits of, 582–583, 583.e11b–583.e12b, 582.e2f, 583.e1fchemical irritation and, 204, 205fextraction of impacted third molars in, 202–203, 202b, 203f–204fgingival trauma in, 200–201, 201fopen gingival embrasures, 582oral jewelry in, trauma with, 203, 203b, 205fperiodontal complications associated with, 200–202plaque retention and composition in, 200radiation therapy and, 206–207self-inflicted injuries in, 203–204, 203b, 204ftissue response to, 201–202, 201b, 202ftoothbrush trauma in, 203–204, 205fOrthodontic tooth movement, 582Orthodontics, 582–584, 584.e1b–584.e4b, 584.e1f–584.e3facceleration, 583.e20–583.e21, 583.e20bstimulatory devices, 583.e20–583.e21surgical methods for, 583.e20implant anchorage in, 583.e14–583.e15, 583.e15f–583.e17fimplant interactions in, 583.e14–583.e21, 583.e14b4914 movement, 583.e19b, 583.e19fsite preparation, 583.e15–583.e19, 583.e18ftreatment phase, 583.e19direct anchorage, 583.e19flowchart for, 583.e20findirect anchorage, 583.e19space management, 583.e19Orthograde periodontitis, 498Orthopedic instability, example of, 338fOrthopedic stability (maintenance), TMJ (impact), 338OSA, Obstructive sleep apneaOSFE, Osteotome sinus floor elevationOsseointegrated implant, 733fOsseointegration, 732, 733b, eviiachievement, 735implant therapy principles, 785blandmark discovery, 867Osseous coagulum, 646.e1Osseous craters, 325, 583.e1diagrammatic representation of, 323f, 325fOsseous defectscombined type of, 321b, 325forthodontic treatment, 583.e1–583.e9, 583.e3bpalatal wall, correction, 641.e8fOsseous lesions, 484fOsseous resection technique, 658, 641.e1–641.e3instrumentation, 641.e1–641.e2postoperative maintenance, 641.e4Osseous resective surgery, 639bOsseous reshaping situation, 641.e4–641.e9Osseous surgery, 663.e21–663.e234915 defining, 636usage, 641.e1fOsseous topography, 44–45Ostectomy, 637flap placement, pocket depth, 641.e6f–641.e7frequirements, 639simplicity, 836variation, 639Osteitis fibrosa cystica, 212.e2Osteoblasts, 35, 43, 152tgrowth factors, in vitro effects, 651tOsteoclasts, 35Osteoconduction, 645, 794.e3Osteocytes, extension, 43Osteoectomy, 637Osteogenesis, 645, 794.e3Osteogenic protein-1 (OP-1), 815.e1Osteogenin, 815.e1Osteoid, 220.e1Osteoinduction, 645, 794.e3Osteonecrosismedication-related, of jawbone, L-PRF and, 673.e1zoledronic acid-related, e106f–e107fOsteonecrosis of the jaw (ONJ), 220Osteopenia, 474.e1, 224.e1tOsteoplasty, 626, 637bony ledge, reduction, 641.e9fflap placement, pocket depth, 641.e6f–641.e7fusage, 640fOsteoporosis, 321, 474.e1, 224.e1–224.e2, 224.e1t4916 types of, 750Osteoprotegerin (OPG), 52Osteoradionecrosis, 207risk, reduction, 751Osteotome instruments, 808, 808.e1fOsteotome sinus floor elevation (OSFE), 808, 811fOsteotome sinus lift, complications related to, 856.e2–856.e3Osteotome technique, clinician comments, 810bOsteotomy, 786fOtolaryngologic symptoms, 339.e2Outcome-based study designs, 85Outcomes, evaluation, 8Outer (oral) epithelium, 24Outpatient surgery, 599–600, 601b, 608.e1ballergy, 602anesthesia, 600dressingantibacterial properties of, 602preparation and application of, 602–604removal of, 604–605retention of, 602emergency equipment, 600excisional/incisional instruments, 605–606first postoperative week, 604hemostasis, 600–602infection transmission, prevention (measures), 600informed consent, 600mouth care, 605noneugenol dressing, 602patient preparation, 600.e1periodontal packs, 602–604postoperative instructions, 6044917 postoperative pain, management of, 605premedication, 600.e1redressing, 604return visit, 604–605scaling and root planing, 600sedation, 600surgical instruments, 605–607surgical pack, 603ftissue management, 600tooth mobility, 605zinc oxide-eugenol dressings, 602Ovate pontic, 703, 703f–704fOverall appraisal of the patient, 378Overall prognosis, individual tooth prognosis (differences), 414Overbite, 392Overeruption, 583.e10recession, presence, 51fOverhanging amalgam margin, effects, 509fOverhanging dental restorations, 255Overhanging margins, impact, e79fOxidized cellulose, 601Oxidized regenerated cellulose, 602Oxidizing lozenges, 529Oxytalan fibers, de novo development, 34–35PPAAP, Platelet-aggregation-associated proteinPAG, Periodontitis-associated genotypePaget disease, 39.e1Pain, in probing, 3894918 Palatal denture, 783.e1Palatal erythematous candidiasis, 366fPalatal gingiva, pseudomembrane formation, e105fPalatal glands, 593Palatal interdental papillae, 20fPalatal maxilla, 611–612Palatal pseudomembranous candidiasis, 366f, 367.e1fPalatal tissue, papilloma, e83fPalatal torus, clinical photograph of, 596fPalatal wall socket osteotomy, 825fPalatedenture stomatitis, 137fhistologic frontal section of, 593fmixed erythematous/pseudomembranous candidiasis, 366focclusolateral view of, 593fulcerations, 216fPalatine bone, occlusal view of, 593fPalatine process, 593Palatogingival groove, 421fPalm grasp, 545.e3, 545.e3fPalms, hyperkeratosis, e102f–e103fPamidronate (Aredia), 221tPAMPs, Pathogen-associated molecular patternsPanoramic images, familiarity, 754–755Panoramic radiographs, 754–755, 754f, 754tPapillaheight, anticipated, 782tmanagement, 612–613presence, 583.e10–583.e114919 preservation flap, 618, 622, 645design, 613fselection, 589sulcular incisions, facial view, 626fpreservation technique, 612–613reconstruction, 680f, 663.e18–663.e19, 663.e19b, 663.e19f–663.e21fPapilla-sparing technique, 707fPapillary form, gingival embrasure volume (relationship), 703fPapillary gingivitis, 248Papillary height, establishment of, 702Papillary inflammation, 56fPapillary layer, 27Papilloma, appearance, e83fPapillomaviruses, recovery, 135tPapillon-Lefèvre syndrome (PLS), 350, 218.e2–218.e3, 218.e3fappearance, e102f–e103fand dental implants, 177bhistory of consanguinity, 71fhyperkeratosis, 70fpanoramic radiograph/clinical photographs, 70fParacelsus, eiiParacoccidiomycosis, 137tParadentium, evParafunction, 576–577Parafunctional habits, 751Parakeratinized epithelia, 22Parakeratinized gingival epithelium, 24fParakeratotic layer, 24fParathyroid disorders, 450.e1Paré, Ambroise, eii4920 Parmly, Levi Spear, eiiiParodontium, evParotid gland, duct (Stensen duct), opening, e54fPartially edentulous maxilla, panoramic view, 765fPartially edentulous patients, 742–744aesthetic considerations to, 744with multiple teeth, 742–744, 743fwith single tooth, 744, 744f–745fPartially erupted mandibular third molar, e109fPartial-thickness flap, 613vestibular deepening, 78fPartial-thickness repositioned flap, 790–792, 791f, 792bParticulate bone graft, 795, 795.e1f–795.e2fmaterial, placement/shape, 708fParvimonas micra (detail), 114f–115fPassive eruption, 32steps, 33fPasteur, Louis, eivPAT, Periodontal Assessment ToolPathogen-associated molecular patterns (PAMPs), 159–160Pathogenesis, definition of, 89Pathogenic bacteria, 142periodontal disease risk factor, 410–411Pathogens, prevalence, 142tPathologic granules, observation, 310Pathologic tooth migration (PTM), 334–336first molars, failure to replace, 335–336pathogenesis of, 334–336periodontal support, weakened, 3344921 teeth changes, forces on, 334–336unreplaced missing teeth, 334–335Patientsage, impact, 414anatomic structures, identification of, 753b, 762, 762bassignment, impact, e28bone quantity/quality/volume, assessment, 762–763complaint of, 745, 745bcompliance/cooperation, 418data, digitization, e1evaluation, 757–764, 757binitial examination, 3flong-term follow-up, residual crestal bone height, 810foral hygiene, methods, 864, 865fpathology, exclusion, 762, 762fperiodontal referral, 866preparation, 784registration, e1satisfaction, 871–872, 871f, 872b, 872tPCR, Polymerase chain reactionPDL, Periodontal ligamentPDT, Photodynamic therapyPDWHF, Platelet-derived wound healing factorsPediatric patient, therapeutic considerations, 285–286Pediatric sedation, 432Pedicle autograft, 663.e9–663.e10Pedigrees, patterns, 167–170Pellagra, 220.e1Pellicleacquired pellicle, 123formation, 123–1244922 layers, 123–124microbiology, ecological relationship, 124Pemphigoid, 293–296bullous pemphigoid, 293–294mucous membrane pemphigoid, 294–296pemphigus, clinical resemblance, 297Pemphigus vulgaris, 289t, 291t, 296–298, 296b, 296fcharacterization, e73fdifferential diagnosis, 297–298gingiva, 297fhistopathology, 296–297immunofluorescence, 297microscopic features, 297foral cavity, 296foral lesions, 296treatment, 290f, 298Pencicloviroral lesion healing, association (two-by-two table), 14tusage, 376Penetrance, reduced, 170Penicillin V, use of, 505.e4Penicillins, 559–560allergy, 560bamoxicillin, 560amoxicillin-clavulanate potassium, 560clinical use, 559–560pharmacology, 559side effects, 560Penicilliosis, 137tPeptides, antimicrobial, 157–158Percussionimplant, 8624923 sensitivity to, 392, 604Perfusion, India ink (usage), 29.e1Periapical abscesscervical root resorption, computed tomography, 76fperiodontal abscess and, 390f, 390.e3–390.e4Periapical radiographs, 753, 754fadvantage/disadvantage of, 753, 754texamples, 399finformation, 397long-cone paralleling technique, 397schematic diagram, 398fPeriapical radiolucency, 498Pericoronal abscess, 493, 497Pericoronitis, 275–276, 491–492appearance, 275f, e109fclinical features, 275–276complications, 276Peri-implant mucositis, 859treatment of, 865, 866bPeri-implant soft tissue, 735nonsurgical sculpting, 709f–710fseal, 852bthree-dimensional sculpting, 710fPeri-implant sulcushealing, 712focclusal view of, 712fPeri-implant tissuesclinical appearance of, 736fground section of, 737fPeri-implantitis, 147–148, 197–198, 197b, 198f, 853–854, 854f, 860f,e30–e314924 management of, lasers for, 694.e2–694.e3, 694.e2ftreatment of, 865–866Peri-implants, 732–740, 740.e1bdiseaseevaluation, 862–863treatment, 865–866healthassessment, 862–864evaluation, 862–863, 863binflammation, presence, 863probing, 860–861, 861b, 861fPerio-Aid, utilization, 658fPerioCol-CG, e10fibers, packaging, e10fPerioCol-TC, e10–e11Periodontal abscess, 313–314, 403–404, 493, 628, 390.e3acute, 390.e3acute lesions, 147case scenario, 497.e1bchronic, 497f, 390.e3classification, 493bclinical pictures, 148fdeep furcation invasions, location, 494fdeep periodontal pocket, 497bdifferential diagnosis, 495bformation, occurrence, 313–314and gingival abscess, 390.e3infection, extension, 313inflammation, lateral extension, 314of left central incisor, e108fof maxillary first molar, e108fmicroscopic view, 315fand periapical abscess, 390f, 390.e3–390.e4pre/posttreatment, e109f4925 pulpal abscesses, differences, 493radiographic appearance, 404fseparation of, 505.e2signs and symptoms, 495bsubgingival calculus, removal, 493btreatment, 493–497options, 496bupper right central incisor, 314fPeriodontal Assessment Tool (PAT), 412.e2Periodontal attachment, documentation of, 344fPeriodontal bone lossbisphosphonates and, 223differentiation, 401Periodontal bony defects, L-PRF for, 669, 669b–670b, 670f, 671tPeriodontal breakdown, e88fperiodontal stability (balance), 565.e2fPeriodontal charting, 390.e2f, e1, 390.e1–390.e4screenshot, e2fPeriodontal classifications, for dental extraction, 836, 836tPeriodontal conditions, 463assessment, diagnostic test for, 87clinical measurement, 82–83true and surrogate measures, 83epidemiologic measures, obtaining, 83–84, 84tperiodontal disease versus, 87Periodontal continuum, anatomic considerations of, 498Periodontal cyst, asymptomatic characteristic, 315Periodontal dental education, article, 476.e2Periodontal destructionClass III malocclusion, e57fin Down syndrome, 218.e3f4926 periods of, 320Periodontal diagnosis, 393–396microbial tooth deposits, 410–411Periodontal diseases, 369–372, 382, eiactivity, 311–312acute respiratory infections and, 235.e4age, impact, 411asthma and, 235bacteria and, 163brole of, 500bleeding on probing, 412.e1bone destruction, 316–327, 398–402patterns, 322–327bone formation, 322bone irregularities, 641.e4fbone morphology, factors, 321–322cancer, 163.e2cardiovascular diseases and, 163.e1–163.e2case scenario, 412.e3b, 409.e2b, 409.e2f, 111.e1b, 412.e3f, 409.e1b, 409.e1fcauses of, 85–87, e52chronic inflammation in, 162–163chronic obstructive pulmonary disease and, 235.e3–235.e4classification, 56bclinical management, goal, 477clinical risk assessment for, 412.e1–412.e3, 412.e1b, 412.e2fcomplicating factors, 139–140coronary heart disease/atherosclerosis and, 228–233development, beneficial species (impact), 143diabetes mellitus, 233–235, 234bimpact, 410diagnosis, 87–88normative/arbitrary values for, 87risk-based reference values, 87therapeutic reference values, 87ecologic plaque hypothesis, relationship, 138f4927 education and scoring systems for, 520.e4–520.e5epidemiologic measuresobtaining, 83–84, 84ttranslation into traditional, 83etiologic agents, 410–411etiology, smoking, effects, 184–187, 186tfundamentals in methods of epidemiology, 80–88gender, impact, 411–412genetic factors, 411genetics of, 166–180, 180.e1b, 180.e1fimmunopathology, 175techniques for studying, 171tterms relevant to, 168t–169thistopathology, 90–94HIV/AIDS, 412.e1immune responses, 103–109, 162–163inflammatory mediators in, role of, 97–100infrequent dental visits, 412.e1knowledge of, 225, 236.e1b–236.e2b, 236.e1flinking pathogenesis to clinical signs and disease, 100–102, 101bmanagement, change, 183bmicrobiologic specificity, 137–140microbiology, 184–186microscopic features of, presented by Znamensky, eivfmodifiable causative factors for, 86–87mortality and, 228necrotizing, e48b–e49b, e104–e106nutritional influences, 219–220older adults, 476–477osteoporosis, 412.e1pathogenesis, 89–111, 89b, 151schematic representation, e12fsmoking, effects, 184–187, 186tpathogenic bacteria, 410–411periodontal condition versus, 87pregnancy outcomes, 235.e1–235.e3, 163.e24928 prevalence/severity, smoking (effects), 182–183, 182tprevention, 477previous history of, 412.e1progression of, 725, 725faging, impact, 53–54radiographic aids, in diagnosis of, 397–409, 397bradiographic appearance, 402–406, 402brecurrence of, 719, 720tresolution mediators in, 163risk determinants/background characteristics, 411–412, 412brisk elements, categories, 411brisk factors, 410–411, 410b, 565.e3brisk indicators, 412.e1risk markers/predictors, 412.e1risk-based decision support systems, e5role, 231–233socioeconomic status, 412stress, 412stroke and, 233systemic antimicrobial agents, therapeutic uses, 562tsystemic health and, 235systemic link of, 163.e1–163.e2therapeutic actions for, 164ttobacco smoking, impact, 410treatmentantibiotic regimen, 557tantibiotics, usage, 556ttype 2 diabetes and, 163.e1vitamin C deficiency in, 220.e2–220.e3Periodontal disturbances, blood dyscrasias (association), 213Periodontal dressings (periodontal packs), 602–604, 604bPeriodontal-endodontic lesions, 75Periodontal endoscopes, 5314929 Periodontal examination and diagnosis, 378–396, 381b, 396bcase scenario, 396.e1b, 396.e1fPeriodontal exploration, importance, 639Periodontal fibers, 33–35Periodontal flapsapproach, 631incisions, usage, 611surgery, evisutures, 614.e1btechnique, usage, 631treatment, diagram, 633fPeriodontal health, 143–145aging, 50bmaintenance, 477Periodontal indices, recordation (absence), 285Periodontal infectionantibiotic options, 496bcoronal integrity of, 505.e3daily activity, 230differential diagnosis of, 505.e2–505.e3effects of, 229–231, 235fwith glycemic control in diabetes, 234–235organ systems/conditions influenced by, 226bstroke associated with, 233Periodontal innate immune response functions, 151–152, 152tPeriodontal instrumentsclassification, 531–545parts, 532ftypes, 532fPeriodontal knives (gingivectomy knives), 605, 545.e29–545.e30usage, 6154930 Periodontal lesionsdifferent characteristics of, 503tpresence of, 511Periodontal ligament (PDL), 32–38, 46aging, impact, 52cellsgrowth factors, in vitro effects, 651tproliferation, 52cementicles, 36fdefense cells, 35exposure, scanning electron micrograph, 40ffibers, 33fformation, 41ffibroblasts, 152tformative function, 36–37functions, 36–38involvement of, 216nutritional functions, 37–38physical functions, 36principal fibers, 34radiolucent shadow, 39.e1radiopaque line, 397remodeling function, 36–37replacement, 41.e1role, importance, 52sensory functions, 37–38sensory nerve fibers, 38space width, 397, 406tension/pressure, areas, 330fthickness, 37tvascular supply, 48fvessels, 29containment, 48width, regulation, 384931 Periodontal maintenance curettes, 539, 539b, 539fPeriodontal medicine, in clinical practice, 235–236Periodontal microbiology, 112–150advances, 150Periodontal microsurgery, 676–687advantages of, 677–681, 680faesthetic, 687.e1–687.e2, 687.e1fdelicate tissue manipulation in, 687.e1–687.e2passive primary wound closure in, 687.e2, 687.e2f–687.e4fprecise tailoring in, 687.e1, 687.e1fcoarseness, 681fgoals, 681instruments for, 676f–677fmagnifications systems in, 684–685microsurgical knots in, 687.e4fphilosophy of, 677, 677f–680fsutures in, 685–687, 687fPeriodontal mucogingival surgery, L-PRF for, 671–673, 673b, 674f–675f, 674t, 675bPeriodontal origin, radiographic appearance of, 505.e3Periodontal pack, insertion of, 600b, 603fPeriodontal pain, identification, 339Periodontal pathogenesispathogenesis, 303–306type, 303Periodontal plastic/aesthetic surgery, 660–663aberrant frenum, problems, 661aesthetic surgical therapy, 661blood supply, adequacy, 663case scenario, 663.e29b, 663.e29fclassification of, 661fdonor sites, 6634932 mucogingival line (junction), 663objectives, 660–661orthodontic correction, indication, 662outcome, factors affecting, 662–663, 662brecipientanatomy, 663site, grafted tissue (stability), 663shallow vestibule, problems (association), 661surgical siteplaque/calculus/inflammation, absence, 663trauma, 663techniques, selection criteria, 663terminology, 660tissue engineering, 661Periodontal Plus AB, e11fPeriodontal pocket, 303–315, 315.e1b, 315.e1f, 390.e1bacterial invasion, 307bacterial survival strategies, 116baselateral epithelium proliferation, 306flow-power view, 306fclassification, 303, 304fclinical features, 303histopathologic features, correlation, 304tconcentrations, schematic representation, e13fconversion, 637deep periodontal pocket, probing, 304fdeepening, plaque accumulation, 586fdetection of, 390.e1epithelium, transmission electron micrograph, 308fformation, 305illustration, 304fgranulation tissue, pressure, 336healing lesions, 308–309histopathology, 306–3114933 inactivity/activity periods, 312intraoral habitats, 117tlateral wall, 307fpleiotropic mechanisms, schematic, 569fpostprophylaxis periodontal abscess, 494fpreoperatively, 642.e5fpulp, changes, 312signs and symptoms, 390.e1site specificity, 312soft-tissue wall, 308–309versus sulcus, 303bsurgeryfundamentals, 609–614objective, 609brationale, 609types, 304fPeriodontal pocket wallappearance, 309fremoval, 615scanning electron frontal micrograph, 308f–309fscanning electron micrograph, 308fscanning electron microscope view, 240fPeriodontal pockets, appearance, 583.e2fPeriodontal probes, 531–532, 531bcomposition, 532fexploration, 532ftypes, 532fPeriodontal probing, importance, 639Periodontal proceduresantibiotic prophylaxis regimens, 446tdesign, 696Periodontal reevaluation, 345f–346fPeriodontal regeneration4934 bone morphogenetic proteins for, 651.e1clinical case of, 642.e3fclinical methods of, 642.e2–642.e4enamel matrix derivative for, 647–648future directions for, 651histologic methods of, 642.e2radiographic methods of, 642.e4recombinant human fibroblast growth factor 2 for, 651.e1recombinant human platelet-derived growth factor for, 648–649surgical reentry of, 642.e4Periodontal regenerative procedures, 480, 480bPeriodontal Risk Assessment (PRA), 721–722, 722fPeriodontal Risk Calculator (PRC), 721–722Periodontal space (widening), trauma from occlusion (impact), 406fPeriodontal species (growth), 114f–115fPeriodontal stability, periodontal breakdown (balance), 565.e2fPeriodontal status, malocclusion, relationship, 279Periodontal support, weakened, 334Periodontal surgery, 586b, 609–627, 697–698, 698bclassifications of, 586findications, 588instruments, series of, 606flocalized areas, radiographs, 719f–720foutpatient surgery, 599–600patient instructions after, 604.e1bPiezosurgery for, 833–834, 834b, 834t, 835fSDD, combination, 572techniques, 614–626Periodontal therapyantibiotics, usage guidelines, 561–563in female patient, 465–474, 474.e2bmaintenance therapy, 1884935 nonsurgical therapy, 187outcomes of stress on, 219response, smoking effects, 187–188, 187trestorative care, relationship, 696surgical phase objectives, 585–587surgical therapy/implants, 187–188Periodontal tissuesabscess, 313–314plaque-bacteria association, depiction, 120fpulpal infection on, biologic effects of, 502–504Periodontal treatment, 452bfor attachment loss, 724–726prevention, 724–725, 725f–726ftreatment, 725–726, 725f, 726bdesign, 447for gingivitis, 724, 724bguidelines, 447health status, 372–373maintenance therapy, 373of medically compromised patients, 442–456older adults, 475–478case scenario, 478.e2b, 478.e2foutcomes, smoking cessation (effects), 188–189intervention studies, 188–189phases of, 715fplanning, 477–478protocol, 372–373radiographs, 727fresults of, 724–731, 731.e1b, 731.e1fsupportive, 714–723, 714bappointment, 716bcase scenario on, 723.e1b–723.e2b, 723.e1f–723.e2fexamination/evaluation in, 716, 716f–720f, 716tmaintenance program for, 715–719, 716bphases of, 715fposttreatment patients and risk assessment in, classification of, 721–722, 721t, 722b, 722f4936 rationale for, 714–715, 715brecurrence of periodontal disease in, 719, 720treferral for, 722–723, 723b, 723ftreatment in, 719Periodontal width, comparison, 47tPeriodontal wound healingassessment, 642, 652.e1b–652.e2bpatterns for, 642.e2fPeriodontally accelerated osteogenic orthodontics, 583.e20Periodontally compromised maxillary anterior teeth, clinicalphotograph, 821f–822fPeriodonticslaser applications in, 691–694aesthetic and pre-prosthetic, 691–692nonsurgical, 693–694, 693bocclusion, 574practice of, 446Periodontist, patient referral to, 722–723Periodontitis, 62–71, 64b, 108b, 135–136, 220.e2–220.e3aggressive, 56b, 65–68, 180b, 352–360, 423, 479–487, e48b–e49b, e92antimicrobial peptides in, 158, 158bassociation studies, failure, 174chronic, 56b, 65, 173–177, 175f, 180b, 415f, 423, e48b–e49b, e85–e88lasers for, 693b, 694.e1–694.e2clinical forms, microbial species (prevalence), 142tclinical manifestations, 63–64comparison, 167complement in, 156–157complementary treatment strategies, 567finvolvement, 568consideration, 140developmental/acquired deformities/conditions, 65bendodontic lesions, association, 74–75, e48b–e49bforms, classification, 63t4937 in genetic syndromes, 173, 173b, 174fgingivitis and, relationship of, 316histopathology of, 91–94, 92b, 93fhost susceptibility, systemic condition, 225, 229bimpact, 68–71inherited variation, 173interdental craters, bony topography, 641.e2flocalized tooth-related factors, 65bmanagement of, lasers for, 694.e1–694.e2, 694.e1f–694.e2fmanifestations, 68–71, e97NOD-like receptors in, 155–156nonsyndromic aggressive, 173–177, 175fpathobiology of, 225–226, 225bpathogenesis, 565.e1fpathogens, prevalence, 142tpatients, tooth mortality, 729b, 731tplaque accumulation, causal relationship, 410plaque-related aggressive moderate periodontitis, clinical image, 67fplaque-related aggressive severe periodontitis, clinical image, 68fplaque-related moderate chronic periodontitis, clinical image, 66fplaque-related severe advanced chronic periodontitis, clinical image, 67fplaque-related severe aggressive periodontitis, clinical image, 69fplaque-related slight early chronic periodontitis, clinical image, 66fpregnancy, 15bpresence (identification), dental radiographs (usage), 639prevalence of, Germany and United States, 348fprognosis, 423–424radiographic changes, 402, 402frisk factor, 871role of, in LBW infants, 235.e2–235.e3smokingeffects, 182–183risk factor, 182system model of, 110–111, 111fas systemic disease manifestation, 56b, 423–424, e48b–e49b, e974938 therapy for, 588threshold for, 109–110, 110fToll-like receptors in, 154–155Periodontitis-associated genotype (PAG), 569–571Periodontium, 151abscesses, 74, 147, e48b–e49b, e108–e110adaptive capacity of, 328adaptive remodeling, 331aging, 50–54, 475–476, 475b, 54.e1b, 54.e1fclinical changes, 476effects, 50–53functional changes, 476intrinsic changes, 475periodontal changes, 476bphysiologic changes, 476stochastic changes, 475–476anatomy, 19–49bleeding, 216classification of diseases, 55–79, 79.e1b–79.e5b, 79.e1f–79.e5fdamage, inflammation, 642developmental issues, 279dysfunction/deterioration, 339examination of, 382, 382b, 383fexternal forces, 47–48function, 19–49inflammatory responses in, 94–100, 97binteractions of, 505.e1–505.e2oral ulceration and infection, 216–218periodontal changes, 277–279preparation, treatment sequence, 697bregeneration ability of, 503for restorative dentistry preparation, 696–698control of active disease in, 697–698, 697b–698brationale for, 696, 696bsequence of, 696–697, 697bsleep-related breathing disorders, 4574939 structure, 19–49treatment, aging (response), 54Periodontologyin classical world, eiearly civilizations, eiduring the eighteenth century, eiiihistorical background of, ei–eixin middle ages, eiin nineteenth century, eiii–evduring Renaissance, ei–eiiiin twentieth century, ev–eviiiPeriodontopathogen-host interactions, 143Periodontopathogenic species, intraoral habitats, 117tPeriodontopathogenspresence, microbiological diagnostic tests, 140virulence factors, 148–150, 148bPerioradicular bony lesions, primary periodontal defects causing,505fPerioscopy system, 542–543, 543fPeriostat, 566Periosteal elevators, 607, 613Periosteal separation technique, 663.e6–663.e7Periosteal suture, 614.e5, 614.e5fPeriosteum, 44cellular events, 44components, 44inner layer, 44outer layer, 44Periotest, 861Peripheral blood, neutrophils (collection), 186Peripheral buttressing bone formation, 3224940 Peripheral giant cell granulomas, 266, 267fappearance, e84fPeripheral ossifying fibroma, 266Periradicular abscesses, suppuration and drainage from, 505.e2–505.e3Periradicular diseases, classification of, 502tPeriradicular pathosis, progression of, 501fPerivascular connective tissue, changes (detection), 243–244Perlèche, 220.e1Permanent dentition, attached gingiva (mean width), 20fPernicious anemia, 218.e1, 218.e1fPersonalized treatment, genetics for, 179–180“Person-time” dimension, 82Petechiae, evidence of, 213fPetroleum jelly, application of, 520.e5Peutz-Jeghers syndrome, 252PEZBINs, Polyenolic zinc-binding compounds4941 Phagocytosis, 186Pharmacogenetics, and individualized dentistry, 179–180Phase-contrast microscopy, 527Phase I periodontal therapyelements of, 506procedures in, sequence of, 507–508rationale of, 506reevaluation after, 587, 599, 599bresults of, 507fspecialist treatment, referral decision, 509–510treatment sessions of, 506–507Phase II periodontal therapycriteria for selection method of, 588method selection of, 588–589periodontal surgery, indications for, 588surgical phase objectives of, 585–587Phenotype, 168t–169tPhenylalkylamine derivatives, 260Phenytoin (Dilantin), 260alternatives, 629gingival enlargement and, e64fimpact, 261fPhenytoin-induced gingival enlargement, 259f–260fPhonetic complications, 858Photodynamic therapy (PDT), 508, 693, 693bPhotographic documentation, 381, 381b, 382fPhotostimulable phosphor (PSP) plates, usage, 406Physical examination, 745–746Physiologic mesial migration, bundle bone (association), 44fPhysiologic pigmentation (melanin), 30–314942 Physiologic recession, 32PICO, Population intervention comparison and outcomePicornaviruses, 133recovery, 135tPiezocision technique, 583.e20Piezoelectric bone surgery, 830–839, 830b–831b, Piezosurgerycharacteristics, 830clinical applications, 833–839Piezoelectric surgical techniques, 641.e1–641.e2Piezoelectric ultrasonic units, 546, 548fPiezosurgerybone surfaces prepared with, 832fclinical applications of, 833–839for crown lengthening, 834–836cutting properties of, 831bdescription of, 831bdevice, 830, 831fhealing after, 833, 833binserts, 832bmicroprecision of, 831, 832ffor periodontal surgery, 833–834, 834b, 834t, 835ffor ridge expansion, 839.e1–839.e3, 839.e3fselective cutting, 831–832for sinus lift, 839.e1, 839.e1b, 839.e1f–839.e2f, 839.e4b, 839.e4ffor tooth extraction, 836–837, 836t, 839.e6b, 839.e6f, 837.e1fvisibility of, 832–833, 833bPigmented gingiva, melanocytes (presence), 23fPik pocket tip, 552fPilot drill, 786f, 788Pink aesthetic score, 847Pink porcelain, for implant-supported fixed restoration, 858f4943 Pins, as implants, 733.e1Placebo effects, 17–18Plaqueattachment, 311bacteriaaerobic versus anaerobic, 121.e1fleukocytes, attraction, 240derivation, 144fgrowth, topography (clinical illustration), 126fhypothesis, 138ecologic plaque hypothesis, 138–139nonspecific plaque hypothesis, 137–138, 137binorganic components, 119local factor, 418–419maturation, colonization (relationship), 124–126microcolonies, 122fremoval, proxy brush for, 658fsite specificity, 122unattached plaque zone, 311Plaque accumulation, 138fextensive, e53fhemophilia-A patient, e63fimpact of, 349, 586fperiodontitis, causal relationship, 410Plaque biofilmand bleeding scores, significance of, 520.e5case scenario, 520.e6b, 520.e6fchemical agents for, 520.e3bchemical inhibitors of, 511–512chlorhexidine rinse for, 520.e3control instruction, 507control record, 520.e5disclosing agents for, 520.e3, 520.e4fessential oil rinse for, 520.e34944 oral rinses for, 520.e2–520.e3patient motivation and education for, 520.e3–6, 520.e4f, 520.e6bremoval, 507–508frequency of, 520.e3in vivo generation, intraoral device (usage), 119fPlaque control, 487.e1checking of, 716–719Plaque formationdebridement/oral hygiene instruction, e59fdiaphragmatic representation of, 124.e2fextensive, e52fprocess, phases, 124variables, 127–128, 127bPlaque-induced gingival diseases, 280–282, e48b–e49b, e49–e51calculus, 280clinical features, 280disease, microbiology, 280–281localized tooth-related factors, 65b, 75–77Plaque-induced gingivitis, appearance, 280fPlaque-related aggressive moderate periodontitis, clinical image,67fPlaque-related aggressive severe periodontitis, clinical image, 68fPlaque-related gingivitis, 56fPlaque-related moderate chronic periodontitis, clinical image, 66fPlaque-related severe advanced chronic periodontitis, clinicalimage, 67fPlaque-related severe aggressive periodontitis, clinical image, 69fPlaque-related slight/early chronic periodontitis, clinical image, 66fPlasma cell gingivitis, 258–259, 258fappearance, 302fPlasma cells4945 infiltrate, biopsy, 61fpredominance, 245–247Plasma membrane TLR signaling, 153Plaster of Paris, 647.e1Plastic instruments, for implants, 540, 540b, 540fPlastic surgery techniques, 585Platelet-aggregation-associated protein (PAAP), expression of, 230–231Platelet concentratesfibrin sealers to, 664first generation of, 665, 665f, 665tsecond generation of, 665–666, 665tPlatelet-derived wound healing factors (PDWHF), 664Platelet-rich fibrin, 665–666, 665tPlatelet-rich plasma (PRP), 665t, 815.e1–815.e2use of, 647Platelets, in L-PRF, 667, 667bPlatform-switched implants, 863, 864fdesign, 772, 773fPleiotropic mechanisms, schematic, 569fPLS, Papillon-Lefèvre syndromePlunger cusps, 198PMN, Polymorphonuclear leukocytePMS, Premenstrual syndromePneumatization, of maxillary sinus, 806, 806bPneumonia, impact, 477Pocket depthmesiobuccal surface, e41folder persons, 476.e6f4946 residual, 637bPocket epithelium, removal of, 644–645biomodification of root surface for, 645.e3–645.e4chemical agents for, 645.e3curettage for, 645.e3, 645.e4bsurgical techniques for, 645.e4Pocket marker, usage, 617fPocket reduction surgery, 313b, 585contents, 310critical zones in, 587–588depthamounts of recession, 312fattachment loss/bone loss, relationship, 312reduction/elimination technique, 618diagram, 311feradication, 625fpocket elimination versus pocket maintenance, 587pocketsalveolar bone, base (area), 312relationship, 312–313problems, approaches, 588–589results of, 586–587, 586fPocket wallsbacterial penetration, 118fscanning electron micrograph, 308fulcerated lateral pocket wall, view, 307fPoint-based method, 844Polishing instruments, 531, 543–545Polycythemia, 224.e2Polydipsia, 447Polyenolic zinc-binding compounds (PEZBINs), 573.e1Polymerase chain reaction (PCR), 144t–145t4947 Polymers, 651.e2tPolymorphisms, 168t–169t, 359Polymorphonuclear leukocyte (PMN), 159, 243, 565.e1aggregations, 361–362exit, 244function, deficiencies, 211Polyostotic fibrous dysplasia (Albright syndrome), 252Polyphagia, 447Polysaccharide capsules, production, 149Polytetrafluoroethylene (PTFE)expanded, 645.e1, 645.e1ftape, as abutment screw cover, 780.e1, 780.e2fuse of, 645Polyuria, 447Polyvinyl siloxane (PVS) impression material, as abutment screwcover, 780.e1, 780.e3fPontic contours, ridge modification procedures for, 703.e2, 703.e2f–703.e3fPontic design, 703, 703fPopulation intervention comparison and outcome (PICO), 2bprocess, 2–3question, search terms, 7tPopulations, patterns, 167–170Porcelain fused to metal crowns, usage, 79fPorphyromonas gingivalis, 71, 80, 154–155, 195, 262, 349adhesion capacity, differences (microscopic confirmation), 118fcounts, 184–186details, 114f–115fetiologic agent, 410–411glycocalyx/polysaccharide capsule, 150fimmune system interaction, 105t4948 prevalence, 363role, increase, 52Portable volatile sulfur monitor, 525–526Positional tracking, 842Positive airway pressure (PAP) therapy, 457, 460–461, 460f, 463.e2bexample, 459fPositive architecture, 638ostectomy, requirements, 639Post trauma, healing, 9fPosterior area, moderate-to-severe periodontitis, 589Posterior left maxilla, CBCT examination, 762Posterior mandibleexposed bone, 223fresorbed ridge, 823.e5fPosterior mandibular vertical ridge augmentation, 814fPosterior maxilla, four-unit FPDs in, 855fPosterior right mandible, horizontal deficiency reconstruction of,monocortical block graft for, 798fPosterior teeth, cusp-fossa//cusp-marginal ridge relationships, 576Postoperative assessment, 766–768, 767fPostoperative bleeding, clinical photograph, 849fPostoperative bruising, clinical photograph, 849fPostoperative care, 793for partial-thickness repositioned flap, 792for two-stage implant placement, 790Postoperative pain, management of, 605Posttreatment evaluation, 751–752Posttreatment patients, classification of, 721–722, 722bPostural hypotension, 4444949 Potential respiratory pathogens (PRPs), 235.e4Pouch and tunnel technique, 663.e15–663.e17, 663.e15b, 663.e16fPower-driven instrumentsaerosol production, 549, 549bcardiac pacemakers, 549, 549bclinical outcomes of, 548–549, 548bconsiderations, 548–549overview of, 546, 546broot surface roughness, 549Power instrumentsefficiency, 547tip designs, 547, 548ftype and benefit of, 546–547, 547bPower scalers, mechanism of action of, 546Powered flossing devices, 518favailability of, 517Powered toothbrushes, 513–514, 514bpositioning of, 516fPPD, Probing pocket depthPRA, Periodontal Risk AssessmentPractical molecular biology, of host-microbe interactions, 151–158Practice Guideline on the Management of Acute Dental Traumafrom the American Academy of Pediatric Dentistry, 8PracticeWorks, e3PRC, Periodontal Risk Calculator; PreViser Risk CalculatorPrecementum, 46Predictable aesthetics, surgical strategy for, 818Preeclampsia, 469Pregnancy, 467–472, 212.e1–212.e2, 456.e1–456.e2analgesic administration, 472t4950 antibiotic administration, 472tbreastfeeding, 472clinical management, 470dental radiographs, usage, 471elective dental treatment, 470–471, 471bepulis, 468estrogen, elevation, 470bgingival enlargement, histopathology, 632–635gingivitis, 251b, 467moderate form, 468fseverity, 468fgranulomas, 467–468hormones, role, 468–469local anesthetic administration, 472tlocalized gingival enlargement, e60f–e61fmedications, usage, 471–472oral manifestations, 469–470periodontal manifestations, 467–468, 212.e1fperiodontitis, 15bplaque control, 470pregnancy-associated gingivitis, 146prenatal fluoride, usage, 470progesterone, elevation, 470bpyogenic granuloma, 468fsedative-hypnotic drug administration, 472ttreatment, 470–472algorithm, 471ftumors, 262, 468, 212.e2Pregnancy-associated gingival overgrowthclinical manifestations of, 262–263, 262fetiology of, 262histopathology of, 263, 263ftreatment of, 263Premature rupture of membranes (PROM), 235.e1, 235.e1f4951 Premenstrual syndrome (PMS), 467Premolar area, mental nerve, 591fPremolarsapical area, experimental occlusal trauma, 331fradiograph of, 595fPrenatal fluoride, usage, 470Preoperative dietary restrictions, 435, 435f, 436bPreoperative microsurgery, 829fPreoperative preparation, 434–435, 435bPreoperative radiographs, 706fPreorthodontic osseous surgery, 583.e1Preprosthetic surgery, 698.e1–698.e2alveolar ridge construction in, 698.e2, 698.e5f–698.e6fcase scenario on, 698.e7b–698.e8b, 698.e7f–698.e8fcrown-lengthening procedures in, 698.e1–698.e2, 698.e3f–698.e4f, 698.e4bmucogingival problems, management of, 698.e1, 698.e1fridge preservation in, 698.e1, 698.e2fPressure ulcers, L-PRF application for, 668.e1Preterm, low-birth-weight (PLBW) infants, 468–469, 469bPretreatment evaluation, 744–749, 745bPretreatment periapical radiograph, 583.e2f–583.e3fPrevalence, 81PreViser Risk Calculator (PRC), e5Prevotella intermedia, 262counts, 184–186details, 114f–115fgrowth, 130fpregnancy, 58bprevalence, 363Prevotella melaninogenica, 2624952 Prevotella nigrescens, 142Preweighed twisted threads, use of, 237Prichard surgical curette, 606fPrickle cell layer, 24fPrimary colonizers (dental plaque), 124tPrimary dentition, periodontium, 277Primary endodontic infection, lateral canal-led periodontal defect,from, 500fPrimary herpetic gingivostomatitis, 273–275, 282, 491appearance, 273f–274fclinical features, 273–274communicability, 274–275diagnosis, 274acyclovir suspension, prescription, 491differential diagnosis, 274extraoral/systemic signs/symptoms, 274histopathology, 274history, 274lip/gingiva/tongue, involvement, 275fnecrotizing ulcerative gingivitis, differentiation, 270toral signs, 273–274oral symptoms, 274Primary herpetic infection, 60fPrimary hypertension (essential hypertension), occurrence, 442–443Primary osteoporosis, 750Primary periodontal defects, impact of, 505fPrimary pulpal infection, impact of, 499fPrimary pulpal pathoses, 505.e3Primary sources, 5Primary tooth exfoliation, 2794953 Primary trauma from occlusion, 329–330, 329bPrimary wound closure, 678fpassive, 687.e2, 687.e2f–687.e4fPrincipal components, 178Principal fibers, 33remodeling, 35Prism telescopic loupes, 684–685, 684f–685fProbeangulation, 388.e1automatic periodontal, 388.e1bleeding in, 388–389, 389bcritical probing depth, 509depth, 63b, 69f, 387–388, 388b, 388felectronic periodontal, 388.e1force, 388.e1pain, 389standard, referral, 509fwhen not to, 383f, 386f, 387, 387b, 388fProbing, e50fdepths, improvement, combination adjunctive therapies (impact), e30types of, 642.e4fProbing pocket depth (PPD), 868Procaine (Novocaine), eiii–eivProcedure accessibility, microsurgery and, 684fProgesteroneelevation, 470bmicrovasculature permeability, association, 466Prognosis, 414b, 426badverse effects, 414anatomic factors, 419biofilm control, 417–4184954 biofilm (local factor), 418calculus, local factor, 418clinical factors, 414–418definition, 413determination, 413–425factors, 414–421, 414bdisease severity, impact, 414–417, 417benvironmental factors, 418genetic factors, 418local factors, 418–419patient age, impact, 414patient compliance/cooperation, 418prosthetic factors, 419–421provisional prognosis, establishment, 413–414reassessment, 424, 424b–425b, 425frestorative factors, 419–421risk, confusion, 413scheme, 413smoking, impact, 418stress, 418subgingival restorations, 419systemic disease/condition, 418systemic factors, 418teeth, example, 417ftypes, 413–414Progressive disc displacement, 339.e1Proinflammatory cytokine tumor necrosis factor α, 833Proinflammatory mediators, 159–160, 565.e2–565.e3elevations, 565.e2Proliferation, biologic complication, 852PROM, Premature rupture of membranesProof of principle, wound healing, 642, 642bProper diagnosis, 3784955 Prophy-Jet, 544, 544fProprioceptive guidance, 681Pro-resolution versus antiinflammation, 160bProstaglandin E2 (PGE2), 99synthesis, elevation, 466Prostaglandin-endoperoxide synthase (PTGS2), 175Prostaglandins, 96, 97binhibition, NSAIDs (usage), 565Prostanoids, 96Prosthesis screw loosening, 856Prosthetic complications, 846, 856Prosthetic factors, 419–421Prosthetic joint replacement, 456, 456brecommendation 1, 456.e1recommendation 2, 456.e1recommendation 3, 456.e1, 456.e1tProtease inhibitors, 365.e5Proteases, production, 149Protectins, 102, 162, 162fProtein deficiency, 220.e3Proteolytic enzymes, 241Protozoa, 136–137Protrusion, 576Protrusive bruxing habit, appearance, 583.e9f–583.e10fProtrusive excursion, 576Provisional fabrication, immediate, 826–827, 827bProvisional prognosis, establishment, 413–414Provisional restorations, 7014956 gingival third, 708fimplant-retained, 782.e1, 782.e1f, 782.e3ffabrication of, 782.e1t, 782.e2fpolymerizing flowable composite in, 782.e3ftemporary abutments and, 782.e1, 782.e2fsupporting gingival tissue, 827fProximal contact relations, 391Proximal tooth contact, absence, 21fPRP, Platelet-rich plasmaPRPs, Potential respiratory pathogensPseudo-halitosis, 523–524Pseudomembraneformation, e105fremoval, e105fPseudomembranous candidiasis (thrush), 366, 476.e7Psychiatric influence, of self-inflicted injury, 219Psychologic conditions, 751Psychologic stress, 363–364Psychophysical staircase method, 524.e1–524.e2Psychosocial stress, 218, 218bPsychosomatic disorders, 218–219PTFE, PolytetrafluoroethylenePTM, Pathologic tooth migrationPtyalism (sialorrhea), 470Pubertal gingivitis, 281Puberty, 465–466, 212.e1, 212.e1fgingival enlargement, 635gingivitis, 281impact, e59fmanagement, 465–4664957 Puberty-associated gingival overgrowthclinical manifestations of, 263etiology of, 263, 263fhistopathology of, 263treatment of, 263Pulmonary diseases, 454b, 453.e2, 454.e1tPulmonary parenchymal fibrous infiltrate, 72fPulp extirpations, periapical image, 9fPulp tissue, infection of, persistent, 498Pulpal abscessesdifferential diagnosis, 495bperiodontal abscesses, differences, 493separation of, 505.e2suppuration and drainage from, 505.e2–505.e3Pulpal continuum, anatomic considerations of, 498Pulpal diseasesclassification of, 501–502, 502tinitiation of, factors of, 500–501Pulpal infectionbiologic effects of, 502–504differential diagnosis of, 505.e2–505.e3fungi/yeast in, presence of, 502subjective symptoms of, 505.e2–505.e3Pulpal inflammation, extensiveness of, 503Pulpal irritation, primary periodontal defects causing, 505fPulpal lesions, different characteristics of, 503tPulpal origin, radiographic appearance, 505.e3Pulpal pathosis, progression of, 501fPulpectomy, 505.e4Pus formation, e88f, e90f4958 Push scaling, 545.e7–545.e8Putrescine, 528.e1Pyogenic granuloma, 262, 262fclinical/histologic images, 58fof pregnancy, 468, 468fPyridinoline cross-linked carboxy terminal telopeptide of type Icollagen (ICTP), e34Pyrophosphates, 514Pyrosequencing, 141QQuality of life, 476.e10Quasi-experimental studies, meta-analyses, 563Quéntin furcation curettes, 542, 542fQuestionable prognosis, 413Questions, type, 5tQuetin bone mill, 795.e2fQuiescence periods, 311–312Quorum sensing, roles, 130RRadiation dose, 754tRadiation-induced caries, 455, 456fRadiation therapy, 455–456, 751Radicular blending, 641.e2Radiographic assessment, 766–768Radiographic examination, 4b, 393, 394f, 749, 749b, 862, 862b, 862fobjective, 8624959 Radiographic guides, fabrication, 766Radiographic projections, advantages/disadvantages of, 754tRadiographic techniques, 397–398selection factors, 753Radiographsdiscovery of, eivinterpretation, 505.e3occlusal, 753–754panoramic, 754–755, 754fperiapical, 753, 754fscreening, 766RAGEs, Receptors for AGEsRaki, burns and, e82fRamus block graft, usage, 78fRandomization, 16process, bias, 16–17Randomized clinical trials, meta-analyses, 563Randomized controlled trials (RCTs), 5, 11, 80, 84–85, 84tmortality risk, increase, 16bprevention, sample size considerations, 17requirement, 376Randomized studies, confounding (impact), 15–16RANKL, Receptor activator of nuclear factor-κB ligandRapid progression, 725Rapidly progressive periodontitis, 147RAS, Recurrent aphthous stomatitisRatalveolar bone, 43fexperimental occlusal trauma, 330focclusion, 331f4960 periodontal ligament, vascular supply, 48fRat molarbundle bone, 43focclusohorizontal forces, microscopic view, 37fsection, alveolar crest fibers (coronal radiation), 34fRCT, Root canal therapyRCTs, Randomized controlled trialsReal-time micro positioning implant surgery, 840accuracy, 841availability of, 845.e2case scenario, 845.e3bchallenges with, 845clinical advantages of, 845data acquisition, 841–842, 842bidentification, 841navigation, 841–842, 843fregistration, 841–842, 842b, 844robustness/accuracy of, 845.e2safety of, 845.e2sequence of steps for, 841–842, 841f, 842bsystem risk analysis in, 845.e2technical principles and limitations of, 844.e1–844.e2, 844.e1fuses and requirements of, 840–841, 841fRecall intervals, 721tRecall maintenance, methods, 864–865Recall patientsrecall intervals, 721tsupportive periodontal treatment, radiographic examination, 716tReceptor activator of nuclear factor-κB ligand (RANKL), 52, 350Receptors for AGEs (RAGEs), 211–212degrees, appearance, 254fextensiveness, 72f4961 Recession, biologic complication, 852, 854fReciprocal click, 339.e1, 339.e1fRecombinant human bone morphogenetic protein-2 (rhBMP-2),815.e1Recombinant human fibroblast growth factor 2, use of, 651.e1Recombinant human insulin-like growth factor 1 (rhIGF-1), 648Recombinant human platelet-derived growth factor, 648–649Reconstructive surgical techniques, 642–650case, sample of, 649fclinical guidelines for, 650–651, 650fcombined techniques of, 650patient-related considerations, 650.e1therapeutic considerations for, 650.e1therapeutic success of, factors for, 650–651tooth and defect considerations, 650.e1Recovery phase, 439.e4Recurrent aphthous stomatitis (RAS), 274, 275fHIV and, 369.e1Recurrent gingivitis, 248Red complex bacteria, 138, 349Reduced enamel epithelium (REE), 26degeneration, 26fReduced penetrance, 170REE, Reduced enamel epitheliumReef knot, 687.e4Refractory periodontitis, 487.e1–487.e2tetracyclines (usage), 557Regenerated ridge, computed tomography image, 74fRegenerative approaches, comparative analysis of, 643t–644t4962 Regenerative success, clinical photographs/periapical radiographs,481fRegenerative surgery, e30Registration, in real-time micro positioning implant surgery, 841–842, 842b, 844Reintrusion, reason, 583.e7Relative risk, 171tRemote incision, layered suturing technique, 786Removable appliances, long-term use of, 794Removable partial dentures, design of, 199Renaissance, periodontology during, ei–eiiiRenal diseases, 453.e1–453.e2Replaced flap, 631Replanted teeth, 3fReplicative senescence, 475Representative study sample, 13Resective osseous surgery, 636–641, 641.e9bassistance, 640bmethods, 640–641rationale, 636–637selection factors, 638–639terminology, 637–638treatment technique, selection, 636usage, 640Resective periodontal surgery, 345f–346fResidual crestal bone height, minimum, 810fResolution mediators, therapeutic actions of, 163Resolvins, 102, 161–162, 162fResonance frequency analysis (RFA), 8614963 Resorbable barrier membranes, 794.e3Resorbed mandibular posterior ridge, wide-diameter implants forcase presentation, 823.e4dental history and complaints, 823.e4examination and diagnosis, 823.e4–823.e6, 823.e5fsurgical procedure, 823.e6treatmentobjectives, 823.e6options, 823.e6plan and rationale, 823.e6sequence, 823.e6Resorptive process, events (sequence), 43Restoration, recontouring defective, 508Restorative dentistryocclusal stability for, 579–581periodontium preparation, treatment sequence, 697bpreparation of periodontium for, 696–698therapy, rationale, 696, 696btreatment, sequence, 696–697, 697bRestorative factors, 419–421Restorative index, 847Restorative interrelationships, 699–704aesthetic tissue management in, 702–703biologic considerations to, 699–702case scenario, 704.e4b–704.e5b, 704.e4f–704.e5fRestorative materials, fracture, 856, 857fRestorative phase, 427, 429fRestorative therapy, occlusal considerations, 704, 704bResults, reporting (usage), 8Retention method, for partially edentulous treatment, 774–777Reticular connective tissue fiber, 274964 Reticular lichen planus, e71fReticulum cell sarcoma, 267Retinopathy, 164tRetraction, 545.e1–545.e2, 545.e2fRetrievability, screw-retained restorations and, 775–776, 776f–777fRetroactive prayer, impact, 12Retrograde peri-implantitis, endodontic pathosis on, 505.e1Retrograde periodontitis, 498periapical lesion in, extension of, 499fRetromolar triangle, 591Retrovirusesgenera, 133recovery, 136tRetrusion, 576Reversal phenomenon, 194Reverse bevel incision, 610Reversed architecture, 325, 325fRFA, Resonance frequency analysisRhodotorula glutinis, 136Rhythmic masticatory muscle activity, 339Riboflavin deficiency, 220.e1Ridgeaugmentation, localized, 794–802, 805.e1b, 805.e1fexpansion, Piezosurgery for, 839.e1–839.e3, 839.e3fhealing, 711f–712fpreservation, 802–803L-PRF for, 670–671, 672b, 672f, 673tRidge-lap pontic, 703fRiggs' disease, eiii4965 Riggs, John W., eiiiRight central incisor, periodontal abscess (radiographicappearance), 404fRight lateral incisor, vertical defects, 323fRisedronate (Actonel), 221tRisk, 81assessment, definition, 410determinant/background characteristics, 411–412elements, categories, 411bfactors, 410–411, 870–871, 871bimpact, 848first-degree relatives, 170indicators, 412.e1markers/predictors, 412.e1prognosis, confusion, 413Risk-based decision support systems, e5Risk-based diagnosis, 87Risk-based reference values, 87Robicsek, Salomon, eivRöntgen, Wilhelm, eivRoot canal therapy (RCT), 505.e3Root caries, 520.e2root tips, 476.e6fRoot planing, 697, 697fcurette, selection, 534fdefinition of, 545.e11, 545.e11b, 545.e12fRoot sensitivity, 605.e2bRoot surfacebiomodification, 644–645debridement, 563gingival margin, relationship, 51f4966 roughness, 549wall, 310–311Root-planing stroke, 545.e8, 545.e8bRoot-resected teeth, 704.e1, 704.e1fRootsapical portion, movement, 36approximation, 655fcementum, tooth-associated cervical plaque (adherence), 121chronic periodontal abscess, lateral aspect (radiolucent area), 404fconcavities, 421fexposure, 419mandibular first molars, 421fdebridement, importance, 681dentin, formation, 46development, Hertwig epithelial root sheath (role), 46extraction surgical classification, 836tform, 654, 583.e6–583.e7fractures, 76, 76b, 76ffragments, tuberosity enlargement (contact), e70flength, 654, 583.e6–583.e7planingdifficulty of, 510magnified, 683fscaling, usage, 419proximity, 583.e6determination, 44result, 419removal, 658.e1–658.e2decision, 641.e1–641.e2resection, 658.e1–658.e2resorption, trauma-induced areas of, 333shape, 42fsubgingival adaptation, 533ftrunk length, 653–654Rotating magnification element, 685f4967 Rothmund-Thomson syndrome, characterization, e77fRound bur, 788Rubber cups, 543, 543fRubber tips, 518–519Ruptured herpetic vesicles, e66fSS100 calcium binding protein A8 (S100A8), 175Sabuncuoglu, Serefeddin, ei–eiiSaccharomyces cerevisiae, 136SAGE, Semisynthetic glycosaminoglycan etherSaline solution cavitation, impact, 836Saliva, 103–104, 104t, 113, 193, 240–242, 241b, 242.e1b, 242.e1fantibacterial factors of, 241buffers, 241enzymes of, 241high-molecular-weight mucinous glycoproteins, 241impact, 128intraoral habitats, 117tin periodontal pathology, 242proteolytic enzymes in, 241role of, 240t, 242bsubstitutes, 478Saliva incubation test, 528.e1Saliva obscures details, 384, 384fSalivary antibodies, 241Salivary composition, change, 473Salivary glandsaplasia, 173disorders, 3694968 Sample size considerations, impact, 17Sanguinarine, 520.e3Sarcoidosis, 71, 264–265prednisone treatment, 72fpretreatment, 72fScaffoldsavailable, 651.e2ttissue engineering element, 647fuse of, 651.e1–651.e3Scaling and root planing (SRP), 531–546, 567f, 697, 697b, 697f, e7adjunctive therapy, differences, e26, e26bantibacterial effect, e11case scenario, 545.e31b–545.e36b, 545.e31f–545.e35fclinical efficacy, enhancement, e30definition of, 545.e11, 545.e11bdifficulty of, 510evaluation, 545.e23, 545.e23bfurcation, 657instruments, 532–543types, 533foutpatient surgery, 600pocket depth reduction, e14bprinciples of, 545.e11–545.e23, 545.e12b–545.e13btechnique use, 588Scaling proximal surfaces, shank position for, 545.e16fScaling stroke, 545.e7, 545.e7b, 545.e15, 545.e15b, 545.e15fScalloped incisions, 610, 610fScalloped internal bevel incision, 631Schneiderian membrane, 594elevation, 809–811, 812fSchwartz Periotrievers, 539–540, 540f4969 Scissors, 607Sclera, 647.e1Scleroderma, e74fScrew cover, for implant abutments, 780.e1cotton, 780.e1, 780.e1fgutta-percha, 780.e1polytetrafluoroethylene tape, 780.e1, 780.e2fpolyvinyl siloxane (PVS) impression material, 780.e1, 780.e3fScrew loosening, 856Screwmentable crown, 776–777Screw-retained full contour zirconia, 774–777Screw-retained porcelain-fused-to-metal options, 774–777, 775fScrew-retained provisional, 827fScrew-retained provisional restorations, 782.e1f, 782.e3fScrew-retained single provisional crowns, 709fScurvy, 220.e2SDB, Sleep-disordered breathingSDD, Sub-antimicrobial-dose doxycyclineSecond incision, 610–612Second premolar, osseous defect to, 646.e1fSecondary aging changes, 476.e3Secondary colonizersdental plaque, 124tinteractions, 124Secondary hypertension, 442–443Secondary osteoporosis, 750Secondary sources, 5Secondary trauma from occlusion, 329–330, 332b4970 Second-stage exposure surgery, 790–792, 790b, 790f–791fSecreted protein, acidic, rich in cysteine (SPARC), 43Secretory leukocyte protease inhibitor, 369.e1–369.e2Sedation, 600alertness/sedation scale, observer assessment, 439tcapnography, 439, 439bcase scenario, 441.e1bcirculation, 438consciousness, 438, 439tdeep, 434definitions/levels, 432–439depth, continuum, 433fdischarge criteria, 438bdocumentation, 439emergency preparedness, 440–441failures, 439–440administration route, 440tincremental dosing, 431inhalation, 439.e3–439.e4intravenous conscious, consent form/explanation, 435flevels, 433fmaximum recommended dose (MRD), 433mild sedation, protocol, 436bminimal, 432and anxiolysis, 439.e1–439.e4moderate, 438b, 439.e4–439.e6monitoring, 438–439oral, 439.e1–439.e3patient preference, 432fpediatric, 432personnel/equipment, 435–438recovery/discharge, 439safety checklist for office-based, 436bsupplemental dosing, 439.e54971 usage, ADA policy statement, 432ventilation and oxygenation, 438–439, 439tSegregation analysis, 170, 171tSelective beta-adrenergic receptor antagonists (β-blockers), 444tSelective decontamination, 235.e4Selective serotonin reuptake inhibitors (SSRIs), 467Self-applied irrigation, home and, 550, 550bSelf-curing acrylic, overhanging margins/injury (impact), e79fSelf-inflicted gingival dehiscence (induction), fingernail (impact),62fSelf-inflicted injury, psychiatric influence of, 219, 219fSemidestroyed connective tissue fibers, 311Semilunar coronally positioned flap, 663.e11fSemisynthetic glycosaminoglycan ether (SAGE), 573.e1Sequencing, 168t–169tSerial antibiotic therapy, 561–563clinical use, 561pharmacologic implications, 561–563rationale, 561Serum CRP elevations, risk factor, 232Seventh Report of the Joint National Committee on Prevention,Detection, Evaluation, and Treatment of High Blood Pressure(JNC-7) guidelines, 442Severe chronic periodontitis, 347Sex hormones, 239, e59concentration, 469fluctuations, 474.e1Sex steroids, 465bShallow to moderate bony defects, management, 6384972 Shallow vestibule, problems, 661, 661bSharpening cards, 545.e24Sharpey fibers, 33, 38, 735bdeep penetration, 43fpresence, 43Shell composite crown, creation, 826fShock absorption, 36Sialometry, xerostomia screening, 476.e9tSialorrhea (ptyalism), 470Sickle cell anemia, 218.e1Sickle scalers, 531–533, 545.e28, 545.e28fcharacteristics, 533fdesign, 533fsizes, variation, 534fusage, 533fSignal transduction, 168t–169tSignaling molecules, tissue engineering element, 647fSIM/Plant images, 759fSimple diseases, linkage analysis (usage), 170–171Simple Keplerian loupes, 684Simple loop suture, 614.e2fSimple loupes, 684, 684fSimulation software, 840Simultaneous implant placement, 797–799, 807, 809f, 807.e1fSingle cutting edge, use, 545.e9, 545.e9b, 545.e9fSingle-element loupes, 684Single-ended Gracey curettes, collection, 535Single nucleotide polymorphisms (SNPs), 168t–169t, 3514973 Single-rooted teeth, tooth mobility and, 391Single-stranded filaments, fimbriae, 149Single tooth, 744, 744f–745fSingle tooth implant crowns, 775bclinical photograph, 854fgingival margin, 858fSingle-tooth replacement, 744fSinus bone augmentationcomplications related to, 856.e1–856.e3vertical ridge and, 813.e1f–813.e2f, 815bSinus elevationmaxillary, 806–813contraindications and indications, 806–807, 807bpresurgical evaluation for, 807, 808fsimultaneous implant placement for, 807, 809f, 807.e1fsurgical procedures for, 807–813, 807bSchneiderian membrane, perforation, 856.e2fSinus floor elevation, L-PRF and, 671.e1, 671.e1f–671.e2f, 671.e2b–671.e3b, 671.e5fSinus lift, Piezosurgery for, 839.e1, 839.e1b, 839.e1f–839.e2f, 839.e4b,839.e4fSite-specific tip, 551f“Site-time” dimension, 82Skatole, 524.e1Skeletal deformities, e104fSkullbony periodontium, photograph, 637fperiodontium, photograph, 638fSLE, Systemic lupus erythematosusSleepdefinition, 4574974 fragmented sleep, hypnogram, 458fhypnogram, 458fSleep apneacause, 457mainstay therapy, 457Sleep bruxism, 339–340, 458development or increase, 458Sleep-disordered breathing (SDB), 339–340, 457–464, 463.e2bcase scenario, 464.e1b–464.e2b, 464.e1fclinical signs and symptoms, 458communication, 462–463, 463bcomplementary therapies, 460fdefinitions and diagnostic criteria for, 460fdentist, role, 457health status and systems, review, 457–458impact of, 577oral device, 461–462predictor devices, 461signs and symptoms, dental identification, 457–458Sleep-related breathing disorders, 457Slime city, life, 129–131Sling ligation, 614.e1Smokeless tobacco, 181bhyperkeratosis and, e81fSmokershigh-risk patients, 569plaque accumulation/inflammation, e53fSmokingbehavioral factor, 141effects, 182–183, 182t, 187t, 599epidemic, 181–182harm, 1814975 immune-inflammatory responses, 186impact, 418implants and, 751maintenance therapy, 188nonsurgical therapy, 187NUG, relationship, 272periodontal disease (relationship), 181–189, 189.e1b–189.e2b, 189.e1fphysiology, 186–187quitting, patient assistance, 184brisk factor, 871periodontitis, 182status, assessment (challenges), 182bsurgical therapy/implants, 187–188Smoking cessationadvice, barriers/stimulation, 184tbenefit, 189effects, 188–189methods, 185bSNODENT, e4Snoring, vibratory noise, 458SNPs, Single nucleotide polymorphismsSnuff, 204–205Socioeconomic status (SES), impact, 412Socket wall, 43–44responsiveness, 47Sodium benzoate, 520.e3Soft filaments, tip with, 551fSoft palateecchymosis, evidence of, 213fpetechiae, evidence, 213fSoft rubber tip, for oral irrigation, 520.e1f4976 Soft tapered bristles, tip with, 551fSoft tissueaugmentation, case presentation, 820biopsy, 76fcontours, 706fdestruction, mucormycosis (impact), e67fevaluation, 749, 749bhealing, 709fPiezosurgery and, 833, 834finterface, 735–739overbuilding of, in augmentation surgery, 819b, 818.e1parameters, multidisciplinary simple implant care scenario, 711fperi-implantnonsurgical sculpting, 709f–710fthree-dimensional sculpting, 710fpocket wall, 587–588reduction, 612bschematic illustration, 736ftrauma/inflammation, e81fSoftDent, e3Soft-tissue wall, 306bSoles, hyperkeratosis, e103fSolid body implant connection, 772f, 773–774, 774fSolid-state detectors, usage, 406Solobacterium moorei, presence of, 522Sonic instrumentation, 546–554, 545.e21–545.e23SPARC, Secreted protein, acidic, rich in cysteineSpecialized lipid mediators (SPMs), 160–161Specialized mucosa, 19Splicing, 168t–169tSplint placement, radiograph, 3f4977 Splinted porcelain-fused-to-metal crowns, overhanging margins(presence), 823.e2f–823.e3fSplinted teeth, 3fSplinting, 704.e1–704.e2of adjacent implants, 780–781, 780f, 781bSplit-mouth design, 587Split-thickness flap, 613usage, 791fSPMs, Specialized lipid mediatorsSpontaneous bleedingacute myelogenous leukemia, e62f–e63fdesquamation and, with erosive lichen planus, e72fhemophilia-A patient, e63fvon Willebrand disease, e64fSpontaneous tooth cleaning, 129, 129fSporotrichosis, 137tSPT, Supportive periodontal treatmentSpurious associations, induction (schematic representation), 16fSquamous cell carcinoma, 267, 267fappearance of, e84fSquirrel monkey, eruption (studies), 46.e1SRP, Scaling and root planingSSRIs, Selective serotonin reuptake inhibitorsStabident, 444Stability measures, 861Stage I gingival inflammation (initial lesion), 243–244Stage II gingival inflammation (early lesion), 244Stage III gingival inflammation (established lesion), 244–247Stage IV gingival inflammation (advanced lesion), 2474978 Staged implant placement, 803, 809fStandard-diameter implants, 743fStandard grasp, 545.e3, 545.e3fStandard projections, 753–755, 754tStannous fluoride, 529, 520.e3Staple-bone implant, 733.e2Stationary instrument technique, 545.e29–545.e30, 545.e29f–545.e30fStatistical power estimates, 174fStatistical significance, clinical significance (differences), e26–e27Stem cells, 651.e1, 651.e1bin L-PRF, 668Stensen duct (parotid gland duct)calculus formation, e55fopening, e54fupper molars, calculus formation, e54fSteroid hormones, increase, 130Steroid-induced gingivitis, 476Stillman cleft, 255Stippling, 253, 253bvariation, 31Stomatitis medicamentosa, 302Stomatitis venenata, 302Straight incisions, 610, 610fStraight osteotomes, 808.e1fStraight-tip design, 547Stratified squamous epithelium, representative cells (diagram), 22fStreptococcal gingivostomatitis (rarity), 271Streptococcus gordonii DL1, coaggregation, 125f4979 Streptococcus sanguinis (colony morphology), 114f–115fStreptococcus species infections, e65, e65fStreptococcus viridans, 85Stress, 218–219impact, 219, 418and periodontal disease, 351shielding, 733.e7Stress-induced immunosuppression, 219Stroke, 545.e7–545.e8, 545.e7fperiodontal disease and, 233periodontal infection and, 233Studiesdesigns (distortion), conflicts of interest (impact), 18randomization, 16–17systematic review, 17–18Study drug effects (interpretability), results analysis (impact),e28–e29Study sampledefinition, modification, 12representative study sample, 13Sturge-Weber syndrome, unilateral cavernous hemangiomas, e77fSubacute cutaneous lupus erythematosus, 301differential diagnosis, 301treatment, 301Subacute leukemia, periodontal ligament/alveolar bone(involvement), 216Subacute lupus erythematosus, 289tSub-antimicrobial tetracycline (Periostat), usage, 478Sub-antimicrobial-dose doxycycline (SDD), 566action mechanism, 568active treatment, 572.e14980 candidate patients, 571–572clinical research data, 568–571clinical trials, data (summary), 570teffects, 571fgeneral patient populations, 569high-risk patients (smokers), 569local delivery systems, combination, 572periodontal surgery, combination, 572sequencing prescription, periodontal treatment (usage), 572side effects, 572special patient populations, 569–571therapy, benefits (monitoring), 572uses/considerations, 571–572Subepithelial bleeding, formation, e78fSubepithelial connective tissue graft, 663.e11–663.e14, 663.e12f–663.e14fSubgingival air polishing, with glycine, 544, 544b–545b, 544f–545fSubgingival biofilmsbacteria, visualization of, 121.e4foverview of, 121.e2f–121.e3foxygen (scarcity), 131plaque samples, 126.e2fSubgingival calculus, 190, 190b–191b, 191fcementum and, 193fclinical correlation of, 190bcomposition of, 192dark pigmented deposits, 121f, 191felectron microscope view of, 195ffenestration defect in, 196finterproximal spurs of, 192fprevalence of, 190–191Subgingival curettage, 4894981 Subgingival debris, 701Subgingival dental plaquenonpathogenic organisms (impact), 130uncultured Synergistetes, 121.e1fSubgingival irrigation, 520.e2technique of, 520.e2Subgingival margins, 699locations, e80fSubgingival microbiota, composition (differences), 121Subgingival plaquebiofilm, removal of, 507–508composition, 468formation, dynamics, 129location, 121spirochetes, phase-contrast microscopy, 73ftopography, 126–127vitality stain, 144fSubgingival recolonization, primary source, 129Subgingival restorations, 419Subgingival scaling and root planing technique, 545.e14–545.e21,545.e14b–545.e16b, 545.e15fcurette, selection, 534fSubinfection, result, 226Subjects, bacterial transmission, 131–132Sublingual space, 597Submandibular space, 597–598Submarginal incisions, 610–612, 611fabundant keratinized tissue, 612fshallow palate, 612fSubmarginal scalloped incision, 611f4982 placement, 611bSubmental space, 597Submerged implant placement, Two-stage implant placementSubperiosteal implants, 733.e2, 733.e3fSubstance abuse, 751Subtractive osseous surgery, 636impact, 637fSubtractive processes, of implants, 733.e4, 733.e5f–733.e7fSufficient cause, 85, 86fSulcular epithelium, 25, 90, 91bcapillaries, arrangement, 29importance, 25permeability of, 237–238Sulcular fluid (gingival fluid), 27, 237–240collection methods of, 237filter strip in, 238fSulcular incision, 611fSulcus bleeding index, 390.e1Sulfhydryl, 194Supernumerary teeth, plaque formation/gingival inflammation, e59fSuper-resistant bacteria, identification, 131Supine hypotensive syndrome, occurrence, 470Supplemental dosing, 439.e5Supporting matrices, 651.e1–651.e3Supporting structures, vascularization, 48–49Supportive implant treatment, 859–866, 866.e1b, 866.e1fexamination, 859–862, 860brationale, 859, 859bSupportive periodontal treatment (SPT), 714–723, 714b4983 appointment, 716bcase scenario on, 723.e1b–723.e2b, 723.e1f–723.e2fmaintenance program for, 715–719, 716bexamination/evaluation in, 716, 716f–720f, 716trecurrence of periodontal disease in, 719, 720ttreatment in, 719phases of, 715fposttreatment patients and risk assessment in, classification of, 721–722, 721t,722b, 722frationale for, 714–715, 715breferral for, 722–723, 723b, 723fSuppurating gingival fenestration, 682fSuppuration, 386, 386fSuprabony periodontal pocketsdepth, marking, 617ffeatures, 314tinterdental papilla, 305finterdental space, 314foccurrence, 303treatment, gingivectomy (usage), 617fulcerated suprabony periodontal pockets, interdental papilla, 310fSupracrestal bone augmentation, 813–815guided bone regeneration for, 813–815, 814fSupracrestal connective tissue zone, function of, 735Supragingival air polishing, with glycine, 544, 544b–545b, 544fSupragingival calculus, 190, 191f, 383calcification of, 193–194dark-pigmented deposits, 121fdepiction, 121fpresence of, 384f, 387prevalence of, 190–191removaldouble-ended curette (usage), 535fsickle scaler (usage), 533f4984 Supragingival dental plaque, formation, factors, 126–129Supragingival hard surfaces, 113Supragingival irrigation, 520.e1–520.e2Supragingival margin, 699Supragingival plaquebiofilm, removal of, 507–508clinical picture, 121fcomposition, 122filamentous nature, 122fintraoral habitats, 117tlocation, 121progression of, 333Supragingival scaling techniques, 545.e14, 545.e14bSupraperiosteal arterioles, 29Surface free energy, 733.e6–733.e7Surface irregularities, 127fSurface roughness, 733.e4fSurface-to-surface methods, 844Surgical aesthetic goal, 818f, 818.e1, 818.e1fSurgical blades, 605, 606fSurgical bone classification, 837fSurgical chisels, 607Surgical complications, 846, 848–852Surgical curettes and sickles, 606–607Surgical guidescomputer-generated, 760f–761ffabrication, 766Surgical loupes, magnification range, 685Surgical management, 820–8234985 examination and diagnosis, 820, 821f–822ftreatment objectives, 820treatment options, 820–821, 820btreatment plan and rationale, 822treatment sequence, 822Surgical microscope, 685, 686fSurgical performance, improvement, 681Surgical phase, 427Surgical pocket therapy, 585–586Surgical specialists, training, 711–713Surgical therapy, e30Surgical trauma, minimization, 830Surrogate endpoints, 83Surrogates, problems, 14tSurvival bias, 84Susceptible patient, definition, 446Suture, 614.e2–614.e5anchor, 614.e2closed-anchor, 614.e2, 614.e4fcontinuous, independent sling, 614.e2, 614.e3f–614.e4fhorizontal mattress, 614.e2interdental space, placement, 614.e1fmicrosurgical, 685–687, 687fpalatal flap, placement, 614.e1fperiosteal, 614.e5, 614.e5fSuturing, 641.e4geometry of, tissue approximation/coadaptation from, 687.e4fligation, 614.e1microsurgical, 679ffor one-stage implant placement, 793purpose, 614.e14986 technique, 614.e1for two-stage implant placement, 789Swelling, 604Swollen/spongy gingiva, leukemia (primary medical diagnosis), 58fSymblepharon, 294Syncope, 600Syndrome Z, 459Synovitis, 339.e2Syphilis (secondary stage), necrotizing ulcerative gingivitis(differentiation), 271tSystematic review (SR), 5–6use of, 227Systemic antibiotics, 487.e1usage, 563Systemic anti-infective therapy, periodontal diseases, 555–563, 563bcase scenario, 563.e1b, 563.e1fSystemic antimicrobial agentsefficacy, absence, e30therapeutic uses, 562tSystemic conditionsgingival manifestations of, 61, e71–e78impact, 418influence, 208–224oral manifestations, 59Systemic diseaseshost modulation factor, 573.e1–573.e2impact, 418manifestation of, periodontitis as, 68–71, e48b–e49b, e97Systemic health, periodontal disease and, 235Systemic health-related issues, 749–7514987 Systemic infections, 230Systemic link, 163.e1–163.e2Systemic lupus erythematosus (SLE), 289t, 300appearance, 300fSystemic tetracycline, usage, 485bSystemically administered agents, 565–566Systolic blood pressure, increase, 443TTacrolimus, 261Tactile periodontal examination, 385–390of gingival crevice, 387–390, 387bof marginal gingiva, 385–386, 386fTalmudic writings, eiTangible benefits, intangible benefits, differences, 374–375, 374b–375bTannerella forsythia, 71, 349etiologic agent, 410–411Tapered implant design, 733.e2, 733.e3fTargeted oral hygiene, 507Tartar control toothpastes, 514T cells, 106–108, 107f, 108b, 152tTCP, Tricalcium phosphateTeethalveolar bone destruction, e98falveolar ridge and, 764, 764f–765fanatomic factors, 75atrophic periodontal ligament, 48faverage loss of, 726tclenching, 3394988 clinical comparison of, 739–740clinical marks of, 578fcontinuous tooth eruption, 32crowdingcalculus formation, e57fgingival inflammation, e59fcrown, failure, silicone impression of, 826fcusps, dimpling, 458cuticular structures, 27deposits, differences, 122tdiscoloration, tetracycline (relationship), 559bendodontic/periodontal prognosis, 583.e7eruption, 277examination of, 390–393extraction of, ridge healing after, 711ffacial surface, appearance, 249ffracture, 583.e7gingiva, shelflike contour, 31fgingival enlargement, e98firregularity, 662lingual surfaces, dimpling, 458location, 75marginal gingiva, relationship, 31mean periodontal support, 725fmicrovascular topography, 739fmigration, e76fmissing, CBCT examination, 763fmobility, 463, 340.e1movement, 47mucogingival deformities/conditions, 65b, 77nonperiodontal/periodontal causes, 729forthodontic alignment, 583.e11fpain, acute trauma, 328–329pathologic migration, 334–336, 392, 392fperiapical radiograph, 800f–801f4989 physical evaluation of, 340.e2physiologic migration, 47positioneffects, 638fshift, 336preservation, 427prognosis, 417fdifferences, 414proximity, intraoperative periapical radiographs, 766frelative importance of, 583.e7relocation, 583.e18frootseruption, 583.e6–583.e8interradicular dimension, 658.e2scaling of, eiinstruments used for, eiiifshape, problem, 583.e11similarities/differences, illustration of, 178fspontaneous tooth cleaning, 129support, tensional theory, 36total loss, 728–729trauma, 504fvitality, 505.e3wall, surface morphology, 311wasting disease of, 390–391Teething, 277–279, 279bTeflon, 794.e2as abutment screw cover, 780.e1, 780.e2fmembranes, use of, 645Telomere shortening, 475Temporal bone, articular eminence (posterior slope), 338fTemporality, 12Temporomandibular disorders, 339b, 339.e1screening evaluation, 577, 577b4990 Temporomandibular joint (TMJ), 337ache, mandibular repositioning devices and, 463.e2anterior view of, 338fauscultation of, 340.e1case scenario, 341.e1bcross-section, lateral view of, 338fdisharmonies, 577dysfunction, 463symptoms, development, 458evaluation of, 340.e1firm palpation of, 340.e1functional and dysfunctional loading of, 339.e2hypermobility of, 339.e2internal derangement, 339Tension-free wound closure, 681fTenting screw, usage, 74fTetracyclines, 557–559, 645.e4antibacterial doses, long-term use, 557–559clinical use, 557–559pharmacology, 557tetracycline-based products, e10–e11tooth discoloration (relationship), 559bTetradecanol, 528.e1Tetralogy of Fallot, 224.e2, 224.e2fTGF-β, 100Th1 cells, 106Th17 cells, 108Th22 cells, 108Thalassemia, malocclusion/gingival recession, e63fThe Microorganisms of the Human Mouth, eivThe Surgeon Dentist, eiiif4991 Therapeutic drug category, 476.e8tThiamin deficiency, 220.e1Thin maxillary anterior sites, fenestration defect, 799fThinner-diameter tips, 547Third molarsimpaction, 621fpartially erupted mandibular third molar, e109ftraumatic lesion in, from garlic, e82fThreaded cylindrical implant, 733.e2, 733.e3f3-mm twist drill, 788–789Three-dimensional projection screens, 842–844, 843f–844fThree-unit FPDs, radiograph, 848fThree-wall defects, 636mesial, 324ftreatment of, 645, 642.e5fThree-wall intrabony defects, 583.e1Three-walled angular defect, 641.e2–641.e3Thrombin, 602, 602bThrombocytopenia (bleeding disorder), 213f, 453.e1, 218.e1chemotherapy-induced thrombocytopenia, 213fThrombocytopenic purpura, 453.e1, 218.e1, 218.e1fThrombogenesis, 230–231Thrush, 366Thumb grasp, 545.e3, 545.e3fThumb reinforced rest, 545.e5fThumb, skeletal disturbance, e63fThyroid disorders, 450.e1Tilted molar, mesial root, 47f4992 Tiludronate (Skelid), 221tTissue and titanium interrelationship, three-dimensional diagramof, 733fTissue, Atherton, 583.e18Tissue destructionmechanisms, 307tissue-destruction-promoting factors, 149Tissue engineering, 663.e23–663.e29, 663.e23b, 663.e24f–663.e27fwith biologic mediators, 647–649, 647f, 647.e1bTissue fluids, depletion, 36Tissue forceps, 607Tissue inhibitors of metalloproteinases, 305bTissue management, 600one-stage implant placement, 792ftwo-stage implant placement, 785fTissue margin overlap, incorrect bite size, 687.e2fTissue plasminogen activator (t-PA), advantage, 376Tissue reevaluation, 508Tissue response, stages, 330–331Tissue retraction, 701.e3–701.e4, 701.e3f–701.e6fTissue tags, removal, 631Tissue trauma, microsurgery and, 678fTissue-to-implant contact, 733.e1Titanium, 733.e5for periodontal microsurgery, 677, 680fplasma, scanning electron microscope image of, 733.e4fTitanium abutments, 777–778composite bonding agent for, 782.e2fgold color coating, 779f4993 provisional restoration and, fabrication of, 782.e2fTitanium dioxide (TiO2), 733.e5Titanium implants, 732placement, 41.e1Titanium instruments, for implants, 540, 540b, 540f–541fTitanium-reinforced ePTFE, 645.e1Titanium-reinforced (TR) membranes, 794.e2–794.e3Titanium temporary abutment, 827fTitration, 433–434devices, 461TLRs, Toll-like receptorsTMJ, Temporomandibular jointTobaccosmoke, components, 181smokeless, 181bsmoking, e31periodontal disease, 86, 410usecessation, 478.e1implants and, 751Toll-like receptors (TLRs), 94, 153–155, 153fknowledge, 159–160periodontitis, role of, 154–155Toll-like receptor-2-lipoprotein/lipoteichoic acid/peptidoglycanrecognition, 152t, 154Toll-like receptor-4 (TLR-4), 153homodimer protein complex, 154Toll-like receptor-4-lipopolysaccharide recognition, 153f, 154Toll-like receptor-9-CpG DNA recognition, 152t, 153f, 154Toll-like receptor-10 (TLR-10), 1534994 Tonguecleaning, 528coating, 522, 522f, 523bof dorsum, 382, 383fcrenulations (scalloped borders), 458dorsum, 113intraoral habitats, 117tleft lateral border, oral hairy leukoplakia, 368fMiyazaki tongue coating index, 528fpressure, pathologic migration (association), 336fTongue surfacefree energy, clinical impact (photographs), 127firregularities, 127fmicroorganism, adherence, 125fmicroroughness, 127, 128fplaque-bacteria association, depiction, 120froughness, clinical impact (photographs), 127fTongue thrusting, 200, 201fTonsils, 113Tooth aspiration, potential danger, 476.e5fTooth-associated cervical plaque, root cementum (adherence), 121Tooth-blade relationships, 545.e6Tooth extraction, 802example, 417fmicrosurgical tooth extraction, 824, 825fPiezosurgery for, 836–837, 836t, 839.e6b, 839.e6f, 837.e1fsite, implant drilling, 824–825, 825fTooth lossadvanced periodontal disease, 727f–728fpredictors, 188prolongation of, 764untreated periodontal disease, 730f4995 Tooth mobility, 391–392, 391f, 392b, 419, 419b, 605causes, 419complaint, e89f, e98fincreased, 333tactile/visual testing for, 578ftesting for, 577, 577b, 579bTooth mortality, 726–729, 726taverage tooth loss, 728f–730fperiodontal treatment, 727fposttreatment, 727ttherapy initiation, 728funtreated periodontitis patients, 731tTooth pain, mandibular repositioning devices and, 463.e2Tooth surface, 587microbial populations, 119Toothbrush, 512–513design, 512b, 513, 513foptions, 513fmanual, 512fpowered, 513–514recommendation, 512–513, 513buse of, instruction and demonstration on, 520.e5–520.e6Toothbrushingabrasive dentifrice, with, 514fimpact, 253importance of, 528methods, 514–516, 516bsoap toothbrushing, desquamation and, e82fTrackers, 844.e1–844.e2Tracking device, 845Tranexamic acid, 452Transalveolar approach, L-PRF and, for sinus augmentation,4996 671.e2f, 671.e3b, 671.e5fTranscription, 168t–169tTransforming growth factor-β(TGF-β) superfamily, 815.e1Transfusion-transmitted virus (TTV), 456.e3Transgingival interdental probing depth, usage, 611Transgingival probing, 390.e1, 390.e3fusage, 641Transgingival sounding, 653Translation, 168t–169tTransmandibular implants, 733.e2Transseptal fibers, 27interproximal extension, 34reformation, 318f, 320bTrauma from occlusion, 321, 392, 405–406clinical and radiographic signs of, 333–334definition of, 328–330, 328b, 333bimpact, 47injury phase, 406repair phase, 406Trauma, site, irrigation (usage), 3fTraumatic forces, occurrence of, 330fTraumatic lesions, 61, 253–254evolution of, 332fresult, 406reversibility of, 331types, e79Traumatic occlusion, 328Treatmentbenefit, obtaining (likelihood), 375biologic mechanisms, understanding, 375–3764997 clinical relevance, determination, 376clinical significance, assessment, 375effect, size, 375, 375bphase, 439.e4success, 179, 179fTreatment plan, 426–430, 426b, 430bexplanation, 427–429overall, 427therapy, sequence of, 427, 427b–428b, 428f–429fTreponema denticola (spirochete), 195, 349culture difficulty, 114f–115fTreponema microdentium (cultivated strains), 269Treponema pallidum (syphilis), 59–60Triacylated lipoproteins, 154Triangular wooden tips, 519fTriazolam, 439.e1, 439.e1tanxiolytic dosing guidelines for, 439.e2tprecautions and drug interactions, 439.e1bprescription, sample, 439.e3fTricalcium phosphate (TCP), 647.e1Trichomonas tenax, 136Triclosan, 529, 520.e3Trimethylaminuria, 523.e1True endpoints, 83TTV, Transfusion-transmitted virusTuberculosis, 456.e3Tumor-like inflammatory enlargements, 628appearance, 629fTumor necrosis factor, 175Tumor necrosis factor alpha, 98–994998 Tumors, e83Twin studies, 171t2-mm twist drill, 788Two-phase oil-water rinse, 529Two-stage implant placement, 785–792flap closure and suturing for, 789flap design, incisions, and elevation for, 785f, 786–788, 787fimplant site preparation for, 786f, 788–789, 788b, 788fone-stage implant placement versus, 784–785, 785fpostoperative care for, 790second-stage exposure surgery for, 790–792, 790bTwo-wall angular defects, 636Two-walled defects/craters, 638–639Tx methods, 179Type 1 anatomy, 836Type 1 diabetesabscess, presence, 212fmedical management, interindividual variability, 234Type 1 diabetes mellitus, 208–209gingival inflammation/periodontal abscess, impact, e88fType 2 anatomy, 837Type 2 diabetes, 163.e1longitudinal study of, 234long-term history of, 211fPima Indians, 210–211therapeutic actions for, 164tType 2 diabetes mellitus, 209alveolar bone loss/inflammation, e90fType 3 anatomy, 837Type 4 anatomy, 8374999 Type I error rates, 13control, e27Type II error rates, 13UU15/30 scaler, 533ends, 533fUISP, Ultrasonic implant site preparationUlcerated lateral pocket wall, view, 307fUlcerated suprabony periodontal pockets, interdental papilla, 310fUlcerative lesions (erosive lesions), 291Ulcerative stomatitis, chronic, 289t, 291t, 298–299, 299bappearance, 298fdiagnosis, 298–299direct immunofluorescence, 298fhistopathology, 298immunofluorescence, 298oral lesions, 298treatment, 299Ultrasonic cuttingclinical characteristics, 831–833healing, 833, 833bmicroprecision, 831, 832fselective cutting, 831–832visibility, 832–833, 833bUltrasonic implant site preparation (UISP), 837advantages, 837–839Ultrasonic instrumentation, 546–554, 545.e21–545.e23, 545.e21b–545.e22btechnique, 545.e22–545.e23, 545.e22bUltrasonic scalers, 555, 830b5000 Ultrasound, usage, 830Ultra-thin ceramic veneers, 700fUnattached plaque zone, 311Uncontrolled type 1 diabetes mellitusappearance, e88fcomplaints, e91fUndisplaced flap, 619–620internal bevel incision, initiation, 619, 619fUnfavorable prognosis, 413Unilateral fibroosseous expansion, e76fUnited States, eviperiodontal education in, evii–eviiiperiodontitis (prevalence) in, 348f–349fUniversal curettes, 534, 534b, 535f–536f, 545.e8, 545.e8b, 545.e8farea-specific curettes, comparison, 536tGracey curettes, differences, 535types, 534fUnmounted stones, 545.e24Unreplaced missing teeth, 334–335Unruptured herpetic vesicles, e66fUpper molars, calculus formation, e54fUpper premolar, circumferential vertical defect, 321fUpper right central incisor, periodontal abscess, 314fUpper second premolar/molars, facial aspect, 321fUrea, 528.e1Urinary tract infections (women), 116Urticaria, 224.e3Uvula, ulcerations, 371fUvulopalatopharyngoplasty, 4605001 VValproic acid, 260Varenicline, usage, 185bVaricella zoster virus (VZV), 60b, 134t–135tVascular cell adhesion molecule-1 (VCAM-1), 231Vascular supply, inflammation and, 738–739, 739fVasoconstrictor, usage, 601VCAM-1, Vascular cell adhesion molecule-1VDR, Vitamin D receptorVeillonella parvula (anaerobic gram-negative small cocci), 114f–115fVeneers, 700fVenous drainage, 49Venous leg ulcers, L-PRF application for, 668.e1, 668.e2f–668.e3fVertical bite-wing films, usage, 399fVertical bone augmentation, 813–815guided bone regeneration for, 813–815, 814fVertical bone height deficiency, 806Vertical bone loss, 648fmandibular implants, impact, 855fVertical defects (bone), 322–325, 323fVertical grooving, 641.e2advantages, 641.e2Vertical incisions, 612avoidance, 612, 613fVertical maxillary excess, 663.e20–663.e23Vertical orthodontic tooth repositioning, 582, 583bVertical ridge, sinus bone augmentation and, 815b, 813.e1f–813.e2fVesalius, Andreas, eii5002 Vesicular lesions (bullous lesions), 291Vestibular depth, 663.e17inadequacy, e75freestablishment, 78fVestibular fornix, mucogingival ridge defect, 78fVeterans Affairs Dental Longitudinal Study, 228Vienna school, evVincent angina, 271, evVincent, Hyacinthe Jean, evViruses, presence, 133–136Viscoelastic system theory, 36Visibility, 545.e1–545.e2Visual acuity, microsurgery and, 677, 677fVisual periodontal examination, 383Vital root resection, 658.e2Vitamin A deficiency, 220.e1Vitamin C deficiency, 263, 264f, 220.e2–3epidemiologic studies of, 220.e2etiologic factors of, 220.e2gingivitis in, 220.e2periodontitis in, 220.e2–220.e3Vitamin D deficiency, 220.e1Vitamin D receptor (VDR), 175Vitamin E deficiency, 220.e1Volatile sulfur compounds (VSCs), 522, 523bconversion of, 529–530von Recklinghausen disease, Neurofibromatosisvon Willebrand disease, 450spontaneous bleeding/clot formation, e64f5003 von Willebrand factor antigen, increase, 230VPro5, 583.e21VSCs, Volatile sulfur compoundsVZV, Varicella zoster virusWWaerhaug, Jens, eviifWasting, definition, 390Wasting disease, of teeth, 390–391Water-soluble vitamin deficiency, 220.e1–220.e3WBCs, White blood cellsWeakness, feeling of, 604Wegener granulomatosis, 264, 264f, 302.e1appearance, 302.e1fWells, Horace, eiii–eivWeski, Oskar, evWestern blot (WB), for HIV, 365.e3–365.e4Wettability, 733.e6Wharton duct, e55fWhite aesthetic score, 847White blood cells (WBCs)count, reduction, 216involvement, 213Wide-diameter implants, 747fcase presentation, 823.e4dental history and complaints, 823.e4examination and diagnosis, 823.e4–823.e6, 823.e5fsurgical procedure, 823.e6treatment5004 objectives, 823.e6options, 823.e6plan and rationale, 823.e6sequence, 823.e6Widow's peaks (line-angle inconsistencies), removal, 639Wilckodontics, 583.e20Window technique, L-PRF and, for sinus augmentation, 671.e1f,671.e2b, 671.e5f“Witch's chin”, 794.e4Women, urinary tract infections, 116Wooden toothpick, 518–519, 519fWoodson periosteal elevator, 607fWorking side, 576Woven bone, 734, 734b, 734fcharacterization of, 733.e7fXXenografts, 645–646, 651.e2tXerostomia, 206, 242b, 476.e7, 476.e7fcomplaint, 470HIV and, 369mandibular repositioning devices and, 463.e1screeningsialometry, 476.e9ttongue blade to measure saliva for, 476.e10fYYeasts, 136ZZaleplon, 439.e1, 439.e1t5005 anxiolytic dosing guidelines for, 439.e2, 439.e2tprecautions and drug interactions, 439.e1bprescription, sample, 439.e2fZene Artzney, eiiZidovudine, drug-induced hyperpigmentation, 369fZinc, 529Zinc oxide-eugenol dressing, 602Zirconia abutments, 773f, 778, 779fZnamensky, eivZoledronate (Zometa), 221tZoledronic acid-related osteonecrosis, e106f–e107fZonae occludens, 22.e1Zygomatic process, 5935006 Instructions foronline accessThank you for your purchase. Please note that your purchase of thisElsevier eBook also includes access to an online version. Please clickhere (or go to to request an activationcode and registration instructions in order to gain access to the webversion.5007 目录Instructions for online access 5007Title Page 2Table of Contents 4Copyright 41Editors 44Contributors 47About the Book 69About The Authors 71Michael G. Newman, DDS, FACD 71Henry H. Takei, DDS, MS, FACD 72Perry R. Klokkevold, DDS, MS, FACD 74Fermin A. Carranza, DR ODONT, FACD 75Preface 77Acknowledgments 79Video Contents 83Introduction: The Historical Background ofPeriodontology85Chapter Outline 85Early Civilizations 86The Classical World 86The Middle Ages 87The Renaissance 89The Eighteenth Century 91The Nineteenth Century 93The Twentieth Century 98The History of This Book 108References 109Part 1 Evidence-Based Practice 113Chapter 1 Evidence-Based Decision Making 1145008 Background and Definition 115Principles of Evidence-Based Decision Making 117Evidence-Based Decision-Making Process and Skills 119Conclusion 138References 138Chapter 2 Critical Thinking 142Twelve Tools for Assessing Evidence 143Conclusion 171References 171Part 2 Biologic Basis of Periodontology 179Section I Normal Periodontium 180Chapter 3 Anatomy, Structure, and Function of thePeriodontium181Oral Mucosa 182Gingiva 182Periodontal Ligament 228Cementum 244Alveolar Process 258Development of the Attachment Apparatus 273External Forces and the Periodontium 276Vascularization of the Supporting Structures 279References 282Chapter 4 Aging and the Periodontium 306Effects of Aging on the Periodontium 308Effects of Aging on the Progression of PeriodontalDiseases316Aging and the Response to Treatment of thePeriodontium317References 320Section II Classification and Epidemiology of PeriodontalDiseases325Chapter 5 Classification of Diseases and ConditionsAffecting the Periodontium326Gingival Diseases 330Periodontitis 3465009 Medication-Related Osteonecrosis of the Jaw 370Necrotizing Periodontal Diseases 373Abscesses of the Periodontium 376Periodontitis Associated With Endodontic Lesions 376Developmental or Acquired Deformities and Conditions 379References 396Chapter 6 Fundamentals in the Methods of PeriodontalDisease Epidemiology400The Need for Epidemiology 400Epidemiologic Study Designs 414Causes 418Diagnosis 422References 426Section III Etiology of Periodontal Disease 433Chapter 7 Periodontal Disease Pathogenesis 434Histopathology of Periodontal Disease 438Inflammatory Responses in the Periodontium 451Linking Pathogenesis to Clinical Signs of Disease 472Resolution of Inflammation 477Immune Responses in Periodontal Pathogenesis 479Concept of Host Susceptibility 501References 510Chapter 8 Biofilm and Periodontal Microbiology 528The Oral Cavity From a Microbe's Perspective 534Bacteria and Their Biofilm Mode of Living 542Characteristics of Biofilm Bacteria (Life in “Slime City”) 579Bacterial Transmission and Translocation 587Nonbacterial Inhabitants of the Oral Cavity 591Microbiologic Specificity of Periodontal Diseases 606The Transition From Health to Disease 619Virulence Factors of Periodontopathogens 639Future Advances in Periodontal Microbiology 647References 652Chapter 9 Practical Molecular Biology of Host–Microbe6925010 Interactions 692Microbe-Associated Molecular Patterns 693Toll-Like Receptors 697Nucleotide-Binding Oligomerization Domain–LikeReceptors703Complement System 707Antimicrobial Peptides 711Immunomodulatory Therapies 713References 714Chapter 10 Resolution of Inflammation 734Inflammation 735Acute Inflammation Is Self-Limited 738Unresolved Chronic Inflammation in PeriodontalDiseases744Systemic Link 746Therapeutic Actions of Resolution Mediators 753Final Remarks 756References 759Chapter 11 Precision Dentistry 769Genomic Advances in the 21st Century 1098Genetic Basis for Individual Differences in Disease Risk 1113Precision Dentistry: Using Genetics for PersonalizedTreatment1132Acknowledgments 1136References 1138Chapter 12 Smoking and Periodontal Disease 1145The Smoking Epidemic 1145Effects of Smoking on the Prevalence and Severity ofPeriodontal Diseases1150Effects of Smoking on the Etiology and Pathogenesis ofPeriodontal Disease1161Effects of Smoking on the Response to PeriodontalTherapy1166Effects of Smoking Cessation on Periodontal Treatment11715011 References 1176Chapter 13 The Role of Dental Calculus and Other LocalPredisposing Factors1189Calculus 1189Other Predisposing Factors 1208References 1244Section IV Relationship between Periodontal Disease andSystemic Heath1262Chapter 14 Influence of Systemic Conditions 1263Endocrine Disorders and Hormonal Changes 1264Hematologic Disorders and Immune Deficiencies 1283Genetic Disorders 1303Stress and Psychosomatic Disorders 1309Nutritional Influences 1315Medications 1324Other Systemic Conditions 1335Conclusion 1345References 1347Chapter 15 Impact of Periodontal Infection on SystemicHealth1370Pathobiology of Periodontitis 1371Focal Infection Theory Revisited 1375Evidence-Based Clinical Practice 1376Subgingival Environment as a Reservoir for Bacteria 1380Periodontal Disease and Mortality 1380Periodontal Disease, Coronary Heart Disease, andAtherosclerosis1382Periodontal Disease and Stroke 1397Periodontal Disease and Diabetes Mellitus 1399Periodontal Disease and Pregnancy Outcome 1405Periodontal Disease and Chronic Obstructive PulmonaryDisease1415Periodontal Disease and Acute Respiratory Infections 1416Periodontal Disease and Asthma 1419Periodontal Medicine in Clinical Practice 14195012 Periodontal Medicine in Clinical Practice 1419Conclusions 1421References 1425Section V Gingival Pathology 1442Chapter 16 Defense Mechanisms of the Gingiva 1443Sulcular Fluid 1443Leukocytes in the Dentogingival Area 1452Saliva 1454References 1461Chapter 17 Gingival Inflammation 1471Stage I Gingival Inflammation: The Initial Lesion 1473Stage II Gingival Inflammation: The Early Lesion 1478Stage III Gingival Inflammation: The Established Lesion 1480Stage IV Gingival Inflammation: The Advanced Lesion 1484References 1485Chapter 18 Clinical Features of Gingivitis 1490Course and Duration 1491Description 1492Clinical Findings 1495References 1516Chapter 19 Gingival Enlargement 1523Terminology and Classification 1524Diagnosis 1526Types of Gingival Enlargement 1527Other Forms of Gingival Enlargement 1553References 1562Chapter 20 Acute Gingival Infections 1573Necrotizing Ulcerative Gingivitis 1573Primary Herpetic Gingivostomatitis 1589Pericoronitis 1595Conclusions 1596References 1598Chapter 21 Gingival Disease in Childhood 1605Periodontium of the Primary Dentition 16065013 Development 1609Gingival Diseases of Childhood 1613Periodontal Diseases of Childhood 1622Gingival Manifestation of Systemic Disease in Children 1626Oral Mucosa in Childhood Diseases 1628Therapeutic Considerations for Pediatric Patients 1628Conclusions 1631References 1634Chapter 22 Desquamative Gingivitis 1641Chronic Desquamative Gingivitis 1641Diagnosis of Desquamative Gingivitis: A SystematicApproach1643Diseases That Can Manifest as Desquamative Gingivitis 1650Drug-Related Eruptions 1687Miscellaneous Conditions That Mimic DesquamativeGingivitis1689References 1692Section VI Periodontal Pathology 1708Chapter 23 The Periodontal Pocket 1709Classification 1710Clinical Features 1712Pathogenesis 1714Histopathology 1720Periodontal Disease Activity 1738Site Specificity 1739Pulp Changes Associated With Periodontal Pockets 1739Relationship of Attachment Loss and Bone Loss toPocket Depth1739Area Between Base of Pocket and Alveolar Bone 1741Relationship of Pocket to Bone 1741Periodontal Abscess 1745Lateral Periodontal Cyst 1748References 1750Chapter 24 Bone Loss and Patterns of Bone Destruction 17575014 Bone Destruction Caused by the Extension of GingivalInflammation1759Bone Destruction Caused by Trauma From Occlusion 1772Bone Destruction Caused by Systemic Disorders 1773Factors Determining Bone Morphology in PeriodontalDisease1774Bone Destruction Patterns in Periodontal Disease 1778Conclusion 1792References 1796Chapter 25 Periodontal Response to External Forces 1801Adaptive Capacity of the Periodontium to OcclusalForces1801Trauma From Occlusion 1803Stages of Tissue Response to Increased Occlusal Forces 1808Effects of Insufficient Occlusal Force 1814Reversibility of Traumatic Lesions 1815Effects of Excessive Occlusal Forces on Dental Pulp 1815Relationship Between Plaque-Induced PeriodontalDiseases and Trauma From Occlusion1816Pathologic Tooth Migration 1821Summary 1828References 1829Chapter 26 Masticatory System Disorders That Influencethe Periodontium1835Temporomandibular Joint 1836Muscles and Nerves of the Masticatory System 1838Centric Relation 1840Biomechanics of the Masticatory System 1842Dysfunction and Deterioration 1844Orofacial Pain 1849Comprehensive Evaluation 1854Diagnostic Decision Making 1861Acknowledgments 1862References 1864Chapter 27 Chronic Periodontitis 18805015 Clinical Features 1882Risk Factors for Disease 1894References 1905References 1907References 1907Chapter 28 Aggressive Periodontitis 1917Overview 1917Historical Background 1918Classification and Clinical Characteristics 1919Epidemiology 1928Pathobiology and Risk Factors 1931Therapeutic Considerations in Aggressive PeriodontitisPatients1936References 1943Chapter 29 Necrotizing Ulcerative Periodontitis 1950Clinical Features 1951Microscopic Findings 1953Patients With HIV/AIDS 1953Etiology of Necrotizing Ulcerative Periodontitis 1955Malnutrition 1959Conclusion 1960References 1962Chapter 30 Pathology and Management of PeriodontalProblems in Patients With Human Immunodeficiency VirusInfection1966Pathogenesis 1968Epidemiology and Demographics 1970Classification and Staging 1972Oral and Periodontal Manifestations of HumanImmunodeficiency Virus Infection1985Dental Treatment Complications 2017Gingival and Periodontal Diseases 2020Periodontal Treatment Protocol 2031References 2034Part 3 Clinical Periodontics 20605016 Part 3 Clinical Periodontics 2060Section I Diagnosis, Prognosis, and Treatment Plan 2061Chapter 31 Levels of Clinical Significance 2062Tangible Versus Intangible Benefits 2063Size of the Treatment Effect 2064Defining Four Levels of Clinical Significance 2066Summary 2072References 2073Chapter 32 Periodontal Examination and Diagnosis 2076Overall Appraisal of the Patient 2077Health History 2077Dental History 2082Photographic Documentation 2084Clinical Examination 2086Tactile Periodontal Examination 2097Periodontal Charting 2111Examination of the Teeth and Implants 2120Radiographic Examination 2130Laboratory Aids to Clinical Diagnosis 2132Periodontal Diagnosis 2133Assessment of Biofilm Control and Patient Education 2137Conclusion 2138References 2141Chapter 33 Radiographic Aids in the Diagnosis ofPeriodontal Disease2148Normal Interdental Bone 2149Radiographic Techniques 2150Bone Destruction in Periodontal Disease 2154Radiographic Appearance of Periodontal Disease 2159Digital Intraoral Radiography 2172Advanced Imaging Modalities 2174Conclusion 2178References 2182Chapter 34 Clinical Risk Assessment 21855017 Definitions 2185Risk Factors for Periodontal Disease 2187Risk Determinants/Background Characteristics forPeriodontal Disease2190Risk Indicators for Periodontal Disease 2192Risk Markers/Predictors for Periodontal Disease 2194Clinical Risk Assessment for Periodontal Disease 2195Conclusion 2198References 2200Chapter 35 Determination of Prognosis 2205Definitions 2205Types of Prognosis 2206Factors in Determination of Prognosis 2210Prognosis of Specific Periodontal Diseases 2228Determination and Reassessment of Prognosis 2235Conclusion 2238References 2239Chapter 36 The Treatment Plan 2243Overall Treatment Plan 2246Sequence of Therapy 2248Explaining the Treatment Plan to the Patient 2253Conclusion 2255Chapter 37 Electronic Dental Records and Decision SupportSystems2257Functionalities and Components Available in ElectronicDental Records2258Electronic Dental Record Use in Dental Practices 2260Future of Electronic Dental Records and DecisionSupport Systems in Dentistry2268References 2269Section II Management of Patients with Special Needs 2273Chapter 38 Conscious Sedation 2274Rationale for Sedation During Periodontal and ImplantSurgical Procedures2275American Dental Association Policy Statement and22765018 Guidelines for Conscious Sedation 2276Definitions and Levels of Sedation 2279Minimal Sedation and Anxiolysis 2299Moderate Sedation 2308Sedation Failures 2314Emergency Preparedness 2315Conclusions 2316References 2318Chapter 39 Periodontal Treatment of MedicallyCompromised Patients2325Cardiovascular Diseases 2326Endocrine Disorders 2343Hemorrhagic Disorders 2355Renal Diseases 2365Liver Diseases 2368Pulmonary Diseases 2369Medications and Cancer Therapies 2370Prosthetic Joint Replacement 2380Pregnancy 2384Infectious Diseases 2385References 2393Chapter 40 Sleep-Disordered Breathing 2405New and Evolving Role of the Dentist 2405Sleep-Related Breathing Disorders and the Periodontium 2406Dental Identification of Signs and Symptoms 2407Sleep, Breathing, and Apnea 2410Diagnosis of Obstructive Sleep Apnea 2413Treatment Options for Obstructive Sleep Apnea 2416Oral Devices for Mandibular Repositioning 2419Device Design and Compliance 2426Conclusions 2436References 2441Chapter 41 Periodontal Therapy in the Female Patient 2446Puberty 24475019 Menses 2449Pregnancy 2454Oral Contraceptives 2471Menopause 2473Conclusions 2478References 2479Chapter 42 Periodontal Treatment for Older Adults 2494The Aging Periodontium 2495Demographics 2499Dental and Medical Assessments 2520Periodontal Diseases in Older Adults 2529Periodontal Treatment Planning 2531Conclusions 2538References 2540Chapter 43 Treatment of Aggressive and Atypical Forms ofPeriodontitis2549Aggressive Periodontitis 2550Periodontitis Refractory to Treatment 2570Necrotizing Ulcerative Periodontitis 2573Conclusions 2575References 2577Section III Diagnosis and Treatment of Periodontal Emergencies 2584Chapter 44 Treatment of Acute Gingival Disease 2585Necrotizing Ulcerative Gingivitis 2586Primary Herpetic Gingivostomatitis 2595Pericoronitis 2597Conclusion 2598References 2600Chapter 45 Treatment of Periodontal Abscess 2603Classification of Abscesses 2603Specific Treatment Approaches 2611References 2618Chapter 46 Endodontic-Periodontic Lesions 2621Factors Initiating Pulpal and Apical Diseases 26265020 Classification of Pulpal and Apical Diseases 2629Biologic Effects of Pulpal Infection on PeriodontalTissues2632Biologic Effects of Periodontal Infection on the DentalPulp2637Effects of Endodontic Pathosis on Development ofRetrograde Peri-implantitis2639Interactions Between Extraradicular Infection and thePeriodontium2642Differential Diagnosis of Pulpal and Periodontal Infection 2644Treatment Considerations 2649Summary 2652References 2655Section IV Nonsurgical Treatment 2665Chapter 47 Phase I Periodontal Therapy 2666Rationale 2667Treatment Sessions 2669Sequence of Procedures 2670Results 2673Healing 2674Decision to Refer for Specialist Treatment 2675Conclusion 2678References 2679Chapter 48 Plaque Biofilm Control for the PeriodontalPatient2682The Toothbrush 2685Powered Toothbrushes 2689Dentifrices 2691Toothbrushing Methods 2693Interdental Cleaning Aids 2697Gingival Massage 2707Oral Irrigation 2708Caries Control 2712Chemical Plaque Biofilm Control With Oral Rinses 27145021 Frequency of Plaque Biofilm Removal 2717Patient Motivation and Education 2718Conclusion 2724References 2727Chapter 49 Breath Malodor 2739Semantics and Classification 2739Epidemiology 2741Etiology 2742Fundamentals of Malodor Detection 2752Diagnosis of Malodor 2754Treatment of Oral Malodor 2767Conclusion 2774References 2779Chapter 50 Scaling and Root Planing* 2794Classification of Periodontal Instruments 2794General Principles of Instrumentation 2837Principles of Scaling and Root Planing 2873Instrument Sharpening 2912References 2949Chapter 51 Sonic and Ultrasonic Instrumentation andIrrigation2965Power-Driven Instruments: Overview 2966Mechanism of Action of Power Scalers 2966Type and Benefit of Power Instruments 2967Clinical Outcomes of Power-Driven Instruments 2973Principles of Instrumentation 2977Home and Self-Applied Irrigation 2978Mechanism of Action of Irrigation 2978Clinical Outcomes of Irrigation 2986Individuals With Special Considerations 2989Action of a Tip With Filaments Cleaning Around anImplant2990Conclusion 2990References 29925022 References 2992Chapter 52 Systemic Anti-infective Therapy for PeriodontalDiseases2999Definitions 3002Systemic Administration of Antibiotics 3003Serial and Combination Antibiotic Therapy 3018Conclusion 3023References 3026Chapter 53 Locally Delivered, Controlled-ReleaseAntimicrobials3032Background and Objectives 3032Drug Development and Registration 3050Clinical Use 3075Case Reports 3095Conclusions 3097References 3099Chapter 54 Host Modulation 3119Introduction 3119Systemically Administered Agents 3131Locally Administered Agents 3135Host Modulation and Comprehensive PeriodontalManagement3137Sub-antimicrobial–Dose Doxycycline 3141Emerging Host Modulatory Therapies 3157Host Modulation Factors in Systemic Disorders 3159Summary 3160References 3162Chapter 55 Occlusal Evaluation and Therapy 3174Pathogenesis 3175Evidence-Based Decision Making 3175Terminology 3179Occlusal Function and Dysfunction 3180Parafunction 3182Clinical Examination 3183Occlusal Therapy 31885023 Conclusions 3193References 3195Chapter 56 Orthodontics 3200Abstract 3200Keywords 3201Chapter Outline 3201Benefits of Orthodontic Therapy 3202Preorthodontic Osseous Surgery 3205Orthodontic Treatment of Osseous Defects 3208Orthodontic Treatment of Gingival Discrepancies 3223Conclusion 3231References 3232Abstract 3233Keywords 3234Chapter Outline 3234Introduction 3235Implant Interactions in Orthodontics 3236Conclusion 3258References 3269Section V Surgical Treatment 3274Chapter 57 Phase II Periodontal Therapy 3275Objectives of the Surgical Phase 3276Pocket Elimination Versus Pocket Maintenance 3282Reevaluation After Phase I Therapy 3284Critical Zones in Pocket Surgery 3284Indications for Periodontal Surgery 3285Methods of Pocket Therapy 3286Conclusions 3291References 3291Chapter 58 Periodontal and Peri-Implant Surgical Anatomy 3294Mandible 3295Maxilla 3302Exostoses 3311Muscles 33145024 Anatomic Spaces 3314Conclusion 3318References 3322Chapter 59 General Principles of Periodontal Surgery 3325Outpatient Surgery 3326Hospital Periodontal Surgery 3329Surgical Instruments 3354Conclusion 3361References 3363Chapter 60 Periodontal Surgical Therapy 3367Rationale for Periodontal Access Surgery 3367Fundamentals of Periodontal Surgery 3369Periodontal Surgical Techniques 3400Conclusion 3424References 3426Chapter 61 Treatment of Gingival Enlargement 3430Chronic Inflammatory Enlargement 3431Periodontal and Gingival Abscesses 3432Drug-Induced Gingival Enlargement 3433Leukemic Gingival Enlargement 3448Gingival Enlargement During Pregnancy 3449Gingival Enlargement During Puberty 3450References 3453Chapter 62 Resective Osseous Surgery 3457Selection of Treatment Technique 3460Rationale 3460Normal Alveolar Bone Morphology 3461Terminology 3463Factors in Selection of Resective Osseous Surgery 3465Examination and Treatment Planning 3468Methods of Resective Osseous Surgery 3471Osseous Resection Technique 3473Flap Placement and Closure 3480Postoperative Maintenance 34825025 Specific Osseous Reshaping Situations 3483Conclusion 3489References 3490Chapter 63 Periodontal Regeneration and ReconstructiveSurgery3493Assessment of Periodontal Wound Healing 3494Reconstructive Surgical Techniques 3506Factors That Influence Therapeutic Success 3540Future Directions for Periodontal Regeneration 3545Conclusion 3553References 3558Chapter 64 Furcation 3589Etiologic Factors 3590Diagnosis and Classification of Furcation Defects 3590Local Anatomic Factors 3592Anatomy of the Bony Lesions 3595Indices of Furcation Involvement 3597Treatment 3600Nonsurgical Therapy 3601Surgical Therapy 3604Prognosis 3616References 3617Chapter 65 Periodontal Plastic and Aesthetic Surgery 3621Terminology 3622Objectives 3623Cause of Marginal Tissue Recession 3626Factors That Affect Surgical Outcome 3629Techniques to Increase Attached Gingiva 3630Techniques to Deepen the Vestibule 3671Techniques to Remove the Frenum 3672Techniques to Improve Aesthetics 3674Tissue Engineering 3685Criteria for Selection of Techniques 3695Conclusions 36975026 References 3699Chapter 66 Leukocyte- and Platelet-Rich Fibrin 3709Introduction 3710General Characteristics of L-PRF Membranes 3719Extraoral Applications of L-PRF 3725L-PRF in the Treatment of Periodontal Bony Defects 3728L-PRF for Ridge Preservation 3733L-PRF and Sinus Floor Elevation 3738L-PRF and Implant Surgery 3745L-PRF for Periodontal Mucogingival Surgery 3748L-PRF and Medication-Related Osteonecrosis of theJawbone3753Initial Observations on the PRF-Block 3753Conclusions 3757References 3759Chapter 67 Periodontal Microsurgery 3770Philosophy of Periodontal Microsurgery 3772Advantages of Microsurgery 3777Magnification Systems 3786Microsurgical Sutures 3792Aesthetic Periodontal Microsurgery 3794Microsurgical Knots 3801Conclusions 3802References 3802Chapter 68 Lasers in Periodontal and Peri-implant Therapy 3804Laser Physics and Biologic Interactions 3807Laser Applications in Periodontics 3817Lasers in the Management of Periodontitis 3825Lasers in the Management of Peri-implantitis 3829Complications and Risks of Laser Therapy 3831Conclusion 3832References 3834Section VI Periodontal-Restorative Interrelationships 3847Chapter 69 Preparation of the Periodontium for Restorative5027 DentistryRationale for Therapy 3849Sequence of Treatment 3850Control of Active Disease 3851Preprosthetic Surgery 3855Conclusion 3867References 3872Chapter 70 Restorative Interrelationships 3878Biologic Considerations 3879Aesthetic Tissue Management 3906Occlusal Considerations in Restorative Therapy 3922Special Restorative Considerations 3925References 3936Chapter 71 Multidisciplinary Versus InterdisciplinaryApproaches to Dental and Periodontal Problems3943Educational Trends Toward Multidisciplinary SpecialistEducation in Implant Treatment3962The Future 3963Section VII Supportive Care and Results of PeriodontalTreatment3964Chapter 72 Supportive Periodontal Treatment 3965Rationale for Supportive Periodontal Treatment 3968Maintenance Program 3970Classification of Posttreatment Patients and RiskAssessment3982Referral of Patients to the Periodontist 3986Tests for Disease Activity 3988Conclusion 3989References 3991Chapter 73 Results of Periodontal Treatment 3997Prevention and Treatment of Gingivitis 3998Prevention and Treatment of Loss of Attachment 3999Tooth Mortality 4004Conclusion 4017References 40185028 References 4018Part 4 Oral Implantology 4022Section I Biology, Diagnosis, Biomechanics, and Treatment Plan 4023Chapter 74 Peri-implant Anatomy, Biology, and Function 4024Implant Geometry (Macrodesign) 4025Implant Surface Characteristics (Microdesign) 4035Hard Tissue Interface 4045Soft Tissue Interface 4050Clinical Comparison of Teeth and Implants 4062Conclusion 4063References 4065Chapter 75 Clinical Evaluation of the Implant Patient 4077Case Types and Indications 4079Pretreatment Evaluation 4088Risk Factors and Contraindications 4101Posttreatment Evaluation 4108Conclusion 4109References 4111Chapter 76 Diagnostic Imaging for the Implant Patient 4117Standard Projections 4118Cross-Sectional Imaging 4123Interactive “Simulation” Software Programs 4131Patient Evaluation 4136Clinical Selection of Diagnostic Imaging 4146Conclusion 4152References 4155Chapter 77 Prosthetic Considerations for Implant Treatment 4158Implant Considerations 4159Abutment/Prosthesis Considerations for Single Units 4174Management of Partially Edentulous Implant Treatmentin the Aesthetic Zone4202Fully Edentulous: Prosthetic Considerations 4215Conclusion 4228References 42305029 Chapter 78 Basic Implant Surgical Procedures 4247General Principles of Implant Surgery 4248Two-Stage “Submerged” Implant Placement 4251One-Stage “Nonsubmerged” Implant Placement 4270Conclusion 4273References 4275Chapter 79 Localized Bone Augmentation and Implant SiteDevelopment4277Guided Bone Regeneration 4278Localized Ridge Augmentation 4287Alveolar Ridge Preservation/Management of Extractions 4307Conclusion 4315References 4317Chapter 80 Advanced Implant Surgical Procedures 4324Maxillary Sinus Elevation and Bone Augmentation 4325Supracrestal/Vertical Bone Augmentation 4346Growth Factors in Bone Augmentation 4357Conclusion 4360References 4362Chapter 81 Aesthetic Management of Difficult Cases(Minimally Invasive Approach)4369Surgical Strategy for Predictable Aesthetics 4372Immediate Implant Placement for Predictability andAesthetics4376Surgical Management of Difficult Cases (MinimallyInvasive Approach)4380Conclusion 4406References 4408Chapter 82 Dental Implant Microsurgery 4413Conclusion 4428References 4428Chapter 83 Piezoelectric Bone Surgery 4431Clinical Characteristics of Ultrasonic Cutting 4437Clinical Applications 4444Advanced Clinical Applications 44625030 Advanced Clinical Applications 4462Conclusion 4472References 4476Chapter 84 Digitally Assisted Implant Surgery 4481Digitally Assisted Implant Surgery 4483Conclusion 4506References 4508Section III Complications 4514Chapter 85 Implant-Related Complications and Failures 4515Definitions of Implant Survival and Success 4517Types and Prevalence of Implant Complications 4519Types of Dental Implants 4523Surgical Complications 4524Biologic Complications 4534Complications Related to Augmentation Procedures 4546Complications Related to Placement and LoadingProtocols4552Prosthetic or Mechanical Complications 4560Aesthetic and Phonetic Complications 4563Conclusions 4568References 4571Section IV Supportive Care and Results of Implant Treatment 4591Chapter 86 Supportive Implant Treatment 4592Rationale for Supportive Implant Treatment 4593Examination of Implants 4594Assessment of Peri-Implant Health 4602Implant Maintenance 4607Treatment of Peri-Implant Diseases 4609Referral of Patients to the Periodontist 4611References 4613Chapter 87 Results of Implant Treatment 4618Defining Implant Outcomes 4620Factors That Influence Implant Outcomes 4624Aesthetic Results and Patient Satisfaction 46325031 References 4637Part 5 Atlas of Periodontal Diseases 4645Chapter 88 Atlas of Periodontal Diseases 4646Plaque-Induced Gingival Diseases 4651Causes of Periodontal Diseases 4657Gingival Diseases Modified by Systemic Factors 4670Gingival Diseases Associated With Blood Dyscrasias 4673Drug-Induced Gingival Diseases 4678Non–Plaque-Induced Gingival Lesions 4681Gingival Lesions of Genetic Origin 4685Gingival Manifestations of Systemic Conditions 4688Traumatic Lesions: Factitious, Iatrogenic, and Accidental 4700Cysts and Tumors 4710Chronic Periodontitis 4715Aggressive Periodontitis 4724Periodontitis as a Manifestation of Systemic Diseases 4731Genetic Disorders 4734Necrotizing Periodontal Diseases 4742Abscesses of Periodontium 4747Index 47515032

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