PRACTICAL OSSEOUS SURGERY IN PERIODONTICS AND IMPLANT DENTISTRY

PRACTICAL OSSEOUS SURGERY IN PERIODONTICS AND IMPLANT DENTISTRY

Edited by

Serge Dibart, DMDJean-Pierre Dibart, MD

A John Wiley & Sons, Inc., Publication

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Library of Congress Cataloging-in-Publication Data

Practical osseous surgery in periodontics and implant dentistry / edited by Serge Dibart, Jean-Pierre Dibart. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8138-1812-2 (hardcover : alk. paper) 1. Osseointegrated dental implants. 2. Dental implants. 3. Periodontal disease. I. Dibart, Serge. II. Dibart, Jean-Pierre.[DNLM: 1. Oral Surgical Procedures, Preprosthetic–methods. 2. Alveolar Process–surgery. 3. Dental Implantation, Endosseous–methods. 4. Guided Tissue Regeneration, Periodontal–methods. 5. Periodontal Diseases–surgery. WU 500] RK667.I45P73 2011 617.4'710592–dc22 2011009940

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1 2011

Cover images originally published in Compendium of Continuing Education in Dentistry. Copyright © 2011 by AEGIS Communications. All rights reserved. Used with permission.

v

Table of Contents

Foreword viiRay C. Williams, DMD

Contributors ixAcknowledgments xi

Section1:Body-MouthConnection:RelevantPathologiesAffectingDentalTreatment,Guidelines,Prevention,andNecessaryPrecautions 1

Chapter1: BodyWeight,Diet,andPeriodontitis 3Jean-Pierre Dibart, MD

Chapter2: DiabetesandPeriodontitis 11Jean-Pierre Dibart, MD

Chapter3: OsteonecrosisoftheJaw 17Jean-Pierre Dibart, MD

Chapter4: PeriodontitisandCardiovascularDisease 19Jean-Pierre Dibart, MD

Chapter5: Periodontitis,Arthritis,andOsteoporosis 27Jean-Pierre Dibart, MD

Section2:OsseousSurgeryinPeriodontalTherapy 35

Chapter6: ResectiveOsseousSurgery 37Oreste Zanni, DDS

Chapter7: RegenerativeOsseousSurgery:TheUseofGrowthFactor–EnhancedBoneGrafts 51Ulrike Schulze-Späte,

DMD, PhD, Rayyan Kayal, DMD, DSc

Section3:OsseousSurgeryinImplantTherapy 67

Chapter8: Introduction,History,andEmergenceofProstheticallyDrivenImplantPlacement 69Steven M. Morgano, DMD

Chapter9: InterpretationofthePreoperativeCTScan:TheRelationshipofAnatomyandOcclusiontoImplantPlacement 75Albert M. Price, DMD, DSc

Chapter10: ImmediateImplants:ControversyorRiskAssessment? 107Albert M. Price, DMD, DSc

Chapter11: AtraumaticPiezosurgicalExtractions:ASolutionforBonePreservation 127Yves Macia, DDS, Francis Louise, DDS

Chapter12: TheMinimallyInvasiveMaxillarySinusSurgery 145Part 1: Serge Dibart, DMD, Yun Po

Zhang, PhD, DDS (hon), Mingfang Su, DMD, MSc

Part 2: Yves Macia, DDS, Francis Louise, DDS

Part 3: Serge Dibart, DMD, Yun Po Zhang, PhD, DDS (hon), Mingfang Su, DMD, MSc

Chapter13: TheNarrowRidgeintheMaxillaandtheMandibleandItsCorrection:RidgeSplittingUsingPiezoelectricSurgeryandGraftingwithorwithoutSimultaneousImplantPlacement 159Rima Abdallah, BDS,CAGS,DSc,

Serge Dibart, DMD

vi  Table of Contents

Chapter14: AutogenousBlockGraft 179Luigi Montesani, MD, DMD

Section4:OsseousSurgeryinOrthodonticTherapy 193

Chapter15: Piezocision:MinimallyInvasivePeriodontallyAcceleratedOrthodonticToothMovementProcedure 195Serge Dibart, DMD

Section5:FutureDirectionsandDilemmas 203

Chapter16: Computer-AssistedImplantDentistry:PossibilitiesandLimitations 205Saynur Vardar-Sengul, DDS,

PhD, CAGS

Chapter17: EndodonticMicrosurgeryorDentalImplants? 227Obadah Attar, BDS, Cert. Endodontics,

Fellowship Implantology

Section6:RestorationofthePlacedImplant 247

Chapter18: WhatEverySurgeonNeedstoKnowAboutImplant-SupportedProsthodontics 249Steven M. Morgano, DMD, Mohamad

Koutrach, DDS, Fahad Al-Harbi, BDS, MSD, DScD

Index 263

vii

Foreword

I am delighted to be asked to write the forward for this new book on practical osseous surgery. This book is greatly needed in dentistry and, quite frankly, is overdue. I am espe-cially glad that Serge Dibart and Jean-Pierre Dibart decided to undertake this work and to provide the dental profession with a much-needed resource in the management of intraoral bone.

I cannot help but smile when I see the words “bone” or “alveolar bone” or “osseous.” I am reminded of long ago at the start of my graduate training program in periodontology at Harvard under the mentorship of Paul Goldhaber. I did not realize until I arrived in Boston that Paul was a world authority on bone and that he would begin to teach my fellow residents and me all of the intricacies and exciting mysteries of bone. Quite frankly, I thought I was at Harvard to study “periodontal pockets.” I remember that in the first month of the residency program, my classmates and I rotated through orthopedic surgery at Massachusetts General Hospital. Paul wanted us to see the management of bone up close and firsthand. And so we watched as hips, knees, and elbows were repaired or replaced or tumors removed from legs and arms and subse-quent osseous defects grafted. It was an amazing introduc-tion to osseous surgery. And soon thereafter, upon returning to the dental school, we were given new Ochsenbein chisels and Schluger files and shown how to remove and contour the alveolar bony defects associated with periodontitis. We were also taught the initial steps in bone regeneration using allograft material and later, tissue-guiding membranes. It was a phenomenal time of being “immersed” in the training of the surgical management of bone.

Osseous surgery has clearly come a very long way since I was a resident in periodontics. It is extraordinary what has been introduced to dentistry in the last 30 years, and quite frankly, there is no looking back. Resective osseous surgery, while not as popular as it once was, is nonetheless an essential part of managing bony defects in the treatment of periodontitis and placing dental implants. Sophisticated instruments such as the Piezotome have been introduced to make bone cutting and resection easier and with much fewer complications. Bone regeneration for both periodontal disease management and implant placement management has come a very long way. We now have at our disposal signaling molecules such as growth and differentiation factors that can greatly enhance our ability to regenerate bone. Even

as we are adopting specific signaling molecules into our practice, new molecules are being developed that may prove to be more efficacious.

The subsequent introduction of guided bone regeneration principles and techniques has taught us that we can in fact regenerate bone where it is critically needed prior to implant placement. And this new ability to regenerate bone where needed ushered in the era of “prosthetically driven” implant placement. Guided bone regeneration, coupled with bone grafts, signaling molecules, and tissue excluding/guiding membranes have allowed the clinician to dictate where bone will be regenerated. No longer does the mere presence of bone dictate where an implant will be placed. Moreover, extraction sockets are now carefully managed during tooth removal, using a combination of atraumatic techniques, bone grafts, and membranes to ensure maximal preservation of the site.

And now, with no end in sight, osseous surgery has also advanced orthodontic tooth movement. Several years ago the Wilcko brothers brought periodontally accelerated osteo-genic orthodontics to the forefront through a series of intrigu-ing cases presented in publications and at meetings. It became clear that the manipulation of bone through osseous surgery, combined with bone regeneration techniques, could foster quicker tooth movement. A more minimally invasive surgical technique introduced will likely make this approach to tooth movement even more acceptable to orthodontists and patients.

All told, I say “lucky us”. Serge and Jean-Pierre Dibart have provided us with a first-rate book that provides current con-cepts and techniques for managing “bone” in periodontics, orthodontics, and implant dentistry. Realizing how far and how quickly dentistry’s management of osseous conditions has advanced, I look forward to the future and the continual development of this aspect of patient management in den-tistry, knowing that clinicians such as the Dibarts will help advance this very exciting area of dentistry.

Ray C. Williams, DMDProfessor and DeanSchool of Dental MedicineStony Brook UniversityStony Brook, NY 11794

ix

Contributors

Editors

Serge Dibart, DMDProfessor and DirectorGraduate Periodontology and Oral BiologyHenry M. Goldman School of Dental MedicineBoston UniversityBoston MAUSA

Jean-Pierre Dibart, MDRheumatology and Sport MedicinePrivate PracticeMarseille, France

Contributors

Rima Abdallah BDS, CAGS, DScDepartment of Periodontology and Oral BiologyHenry M. Goldman School of Dental MedicineBoston UniversityBoston, MAUSA

Fahad Al-Harbi, BDS, MSD, FACP, DScDDeanCollege of DentistryUniversity of DammamDammamSaudi Arabia

Obadah H. Attar, BDSCertificate in Endodontics, Post Doctoral Fellowship in ImplantologyDScD in EndodonitcsResidentEndodontic DepartmentBoston University Goldman School of Dental MedicineBoston, MAUSA

Rayyan Kayal, BDS, DScDiplomate, American Board of PeriodontologyAssistant Professor and Consultant of PeriodontologyKing Abdulaziz University—Faculty of DentistryJeddahSaudi Arabia

Mohamad Koutrach, DDSAssistant Professor of ProsthodonticsBoston University Institute for Dental Research & Education—DubaiDubai, United Arab Emirates

Francis Louise, DDSProfessor and DirectorDepartment of PeriodontologySchool of Dental MedicineUniversité de la MéditerranéeMarseilleFrance

Yves Macia, DDS, MS (anthropology)Associate ProfessorDepartment of PeriodontologyUniversité de la MéditerranéeMarseilleFrance

Luigi Montesani, MD, DMDSpecialist in Periodontology and Prosthetic DentistryPrivate PracticeRome, Italy

Steven M. Morgano, DMDProfessor and DirectorDivision of Postdoctoral ProsthodonticsDepartment of Restorative Sciences and BiomaterialsHenry M. Goldman School of Dental MedicineBoston UniversityBoston, MAUSA

Albert M. Price, DMD, DScAssociate Clinical ProfessorDepartment of Periodontology and Oral BiologyHenry M. Goldman School of Dental MedicineBoston UniversityBoston MAUSA

x  Contributors

Ulrike Schulze-Späte, DMD, PhDAssistant Professor of Dental MedicineDivision of PeriodonticsSection of Oral and Diagnostics SciencesCollege of Dental MedicineColumbia UniversityNew York, NYUSA

Saynur Vardar Sengul, DDS, PhD, CAGS in PeriodontologyDepartment of Periodontology and Oral BiologyHenry M. Goldman School of Dental MedicineBoston UniversityBoston, MAUSA

Mingfang Su, DMD, MScAssociate Clinical ProfessorDepartment of Periodontology and Oral BiologyHenry M. Goldman School of Dental MedicineBoston UniversityBoston, MAUSA

Ray Williams, DMDProfessor and DeanSchool of Dental MedicineStony Brook UniversityStony Brook, NYUSA

Oreste D. Zanni, DDSAssistant Clinical ProfessorDepartment of Periodontology and Oral BiologyHenry M. Goldman School of Dental MedicineBoston UniversityBoston, MAUSA

Yun Po Zhang, PhD, DDS (hon)DirectorClinical Dental ResearchColgate-Palmolive CompanyPiscataway, New JerseyUSA

xi

Acknowledgments

The authors would like to thank Mary O. Taber for her con-siderable help and expertise in editing and formatting this manuscript. And special thanks to Dr. George Gallagher for providing the histological picture for the book’s cover.

The authors would also like to thank Dr. Gurkan Goktug for his contribution to Chapter 16 and Dr. Anuradha Deshmukh and Anastasios Moschidis for their contribution to Chapter 7.

Section 1Body-Mouth Connection: Relevant Pathologies Affecting Dental Treatment, Guidelines, Prevention, and Necessary Precautions