Oral and Implant Surgery: Principles

J. Thomas Lambrecht (Editor)

Oral and Implant Surgery: Principles

and Procedures

In collaboration with:

A. Dunsche, R. Ewers, A. Filippi,

B. Hoffmeister, Th. Kreusch, K. Wangerin

504 pp.; 1490 figures (mostly color);
ISBN 978-1-85097-184-9

Euro 178,-

Back cover

This book discusses the various factors affecting outpatient surgery performed by oral and maxillofacial surgeons, from a clinical viewpoint. Examples of intraoral operations are presented step-by-step using high-quality color photographs. The text is based on scientific literature from the last ten years, and the appendix offers a rich collection of Internet links. The main focus is the traditional oral surgery of the intraoral soft tissues and the hard dental structures.

A chapter is dedicated to endosseous implantology, as an alternative to tooth-preserving surgery. ‘Safety’ is also a central theme of the book, from the principles of providing preoperative information to patients, intraoperative complications and their possible consequences, through to dealing with at-risk patients.

The authors, many former clinicians at the Department for Oral and Maxillofacial Surgery, Kiel University, aimed to produce an up-to-date overview of developments within their field. By choosing the form of a textbook, they have at the same time created an excellent study guide.

Editor: J. Thomas Lambrecht

Authors: Anton Dunsche

Rolf Ewers

Andreas Filippi

Bodo Hoffmeister

Thomas Kreusch

J. Thomas Lambrecht

Konrad Wangerin

Contents

Anton Dunsche

1 Patient information, preoperative preparation

and medication 1

1.1 Patient information 3

1.1.1 Patient's right to choose and informed consent 3

1.1.2 The purpose of patient information 3

1.1.3 Timing of information 4

1.1.4 Information for non-competent patients and minors 4

1.2 Preoperative preparation 5

1.2.1 Instruments 5

1.2.2 Hygiene: accident prevention 5

1.2.3 Disinfection 10

1.2.4 Sterilization 11

1.2.5 Equipment infrastructure 12

1.3 Medication in the perioperative period 16

1.3.1 Sedatives 16

1.3.2 Local anesthetics 16

1.3.3 Analgesics 17

1.3.4 Antibiotics 18

References 20

Thomas Kreusch and J. Thomas Lambrecht

2 Simple and complicated tooth extraction 21

2.1 General principles 23

2.1.1 Indications for tooth removal 23

2.1.2 Contraindications to tooth removal 23

2.1.3 Anesthesia 23

2.1.4 Preparation of the patient 23

2.1.5 Instruments 24

2.1.6 Inspecting the extracted tooth 26

2.1.7 Treating the tooth socket 26

2.1.8 Aftercare 27

2.2 Special procedure 28

2.2.1 Position of practitioner and patient 28

2.2.2 Removal of primary teeth 28

2.2.3 Removal of anterior teeth 29

2.2.4 Removal of premolars 29

2.2.5 Removal of molars 30

2.2.6 Serial extractions 32

2.3 Complications 34

2.3.1 Slipped instruments 34

2.3.2 Lesions to adjacent teeth 34

2.3.3 Crown fracture 34

2.3.4 Root fracture 34

2.3.5 Thermal damage caused by rotary instruments 35

2.3.6 Nerve lesions 35

2.3.7 Oro-antral perforation 35

2.3.8 Maxillary antral cysts 41

2.3.9 Displacement of teeth/parts of teeth into soft tissue 43

2.3.10 Dry socket 43

2.4 Pre-implantology tooth removal 44

2.4.1 Gentle tooth extraction 44

2.4.2 Stabilization of the alveolar process 44

References 46

J. Thomas Lambrecht and Bodo Hoffmeister

3 Surgical removal of unerupted

and displaced teeth 49

3.1 Mandibular third molars 51

3.1.1 Indications for surgical removal 51

3.1.2 Contraindications 54

3.1.3 Preoperative diagnosis 54

3.1.4 Preoperative medication 56

3.1.5 Risks 56

3.1.6 Surgical technique 57

3.1.7 Aftercare 60

3.1.8 Complications caused by third molar removal 60

3.1.9 Complications caused by leaving third molars in place 65

3.2 Maxillary third molars 67

3.3 Maxillary canines 70

3.4 Other retained teeth 72

References 76

J. Thomas Lambrecht and Andreas Filippi

4 Tooth-preserving surgical procedures 81

4.1 Periradicular surgery 83

4.1.1 Aims 83

4.1.2 Indications and contraindications 83

4.1.3 Operating technique 86

4.1.4 Hemostasis 87

4.1.5 Retrograde filling 89

4.1.6 Wound closure 91

4.1.7 Aftercare and prognosis 91

4.2 Intentional replantation 95

4.2.1 Indications and contraindications 95

4.2.2 Operating technique 95

4.3.3 Aftercare and prognosis 100

4.3 Transplantation 102

4.3.1 Indications, contraindications and planning 102

4.3.2 Tooth transplantation technique 103

4.3.3 Special features of third molar transplantation 104

4.3.4 Splinting 105

4.3.5 Aftercare and prognosis 105

4.4 Corrective surgery 107

4.4.1 Hemisection 107

4.4.2 Premolarization 109

4.4.3 Root amputation 109

4.4.4 Crown lengthening 112

4.4.5 Exposure 112

References 117

Konrad Wangerin

5 Cysts, bone lesions and

odontogenic tumors 121

5.1 Odontogenic cysts 125

5.1.1 Infant gingival cysts 125

5.1.2 Follicular cyst 125

5.1.3 Eruption cyst 129

5.1.4 Lateral periodontal cyst 129

5.1.5 Gingival cyst of adults 130

5.1.6 Glandular odontogenic cyst 130

5.2 Non-odontogenic cysts 132

5.2.1 Nasopalatine duct cyst 132

5.2.2 Nasolabial cyst 135

5.2.3 Fissural cyst 135

5.3 Cysts of inflammatory origin 136

5.3.1 Radicular cyst 136

5.3.2 Residual cyst 139

5.3.3 Periodontal cyst 139

5.3.4 Occlusion cyst 139

5.4 Operating techniques 141

5.4.1 Cystostomy (Partsch I) 141

5.4.2 Cystectomy (Partsch II) 145

5.4.3 Biological filling materials 146

5.4.4 Alloplastic and synthetic filling materials 151

5.5 Bone lesions 153

5.5.1 Osteolytic lesions 153

5.5.2 Osteoplastic lesions 157

5.6 Odontogenic tumors 162

5.6.1 Odontoma 162

5.6.2 Keratocystic odontogenic tumor 163

References 165

Andreas Filippi

6 Traumatology of permanent teeth 169

6.1 Classification and nomenclature of dental injuries 171

6.2 Epidemiology 173

6.3 Action at site of accident 174

6.4 Prevention of dental injuries 176

6.4.1 Fabricating a multilayer mouthguard 176

6.5 Post-traumatic diagnostic procedure 179

6.6 Prognosis of dental injuries 181

6.7 Post-traumatic treatment 182

6.7.1 General treatment 182

6.7.2 Intra/extra-alveolar fractures of the teeth 184

6.7.3 Concussion and loosening of the teeth 186

6.7.4 Dislocation 187

6.7.5 Intrusion 188

6.7.6 Avulsion 192

6.7.7 Post-traumatic splinting 195

6.7.8 General medicinal treatment after dental trauma 200

6.7.9 Anti-resorptive and regenerative medicinal treatments 200

6.8 Late sequelae after dental trauma 203

6.8.1 Late sequelae in the pulp 203

6.8.2 Late sequelae in the periodontium 206

References 220

Anton Dunsche and J. Thomas Lambrecht

7 Intraoral soft tisse surgery 225

7.1 Biopsy 227

7.1.1 Excisional biopsy 227

7.1.2 Incisional biopsy 229

7.1.3 Punch biopsy 230

7.1.4 Brush biopsy 232

7.2 Periodontal surgery 233

7.2.1 Gingivectomy 233

7.2.2 Mucogingival surgery 234

7.2.3 Flap surgery 235

7.3 Pre-prosthetic surgery 243

7.4 Surgery of minor salivary glands 249

7.5 Abscess incision 258

7.6 Benign tumors 262

7.7 Epithelial precursor lesions 266

References 270

Rolf Ewers

8 Implant surgery 271

8.1 Basic principles 273

8.1.1 Indications and contraindications of endosseous implants 273

8.1.2 Principles of planning by Harald Fahrenholz 273

8.1.3 Imaging techniques 275

8.2 Clinical requirements 280

8.2.1 Bone quality 280

8.2.2 Bone supply 281

8.2.3 Osseointegration and functional ankylosis 283

8.2.4 Loading 283

8.2.5 Soft tissue 285

8.2.6 Esthetics by Harald Fahrenholz 286

8.2.7 Incisions 289

8.3 Standard clinical situations 292

8.3.1 Single-tooth gap in anterior region 292

8.3.2 Lateral edentulous gap 295

8.3.3 Free-end situation in the maxilla 298

8.3.4 Free-end situation in the mandible 300

8.3.5 Partially edentulous mandible 301

8.3.6 Edentulous maxilla 303

8.3.7 Edentulous mandible 304

8.4 Augmentation 306

8.4.1 Principles of augmentation 306

8.4.2 Guided bone regeneration 312

8.4.3 Ridge preservation 313

8.4.4 Defect filling 325

8.4.5 Condensing 327

8.4.6 Bone splitting 328

8.4.7 Inlay graft 337

8.4.8 Sinus lift (sinus graft) 350

8.4.9 Onlay graft 360

8.4.10 Distraction 374

8.5 Implant navigation 378

8.5.1 Basic principles by Astrid Reichwein and Kurt Schicho 378

8.5.2 Achievable accuracy levels by Astrid Reichwein and Kurt Schicho 380

8.5.3 Computer-aided planning and template fabrication by Rolf Ewers 380

8.6 Implants for orthodontics by Klaus Sinko and J. Thomas Lambrecht 391

8.6.1 Development 391

8.6.2 Micro-plates with micro-screws 392

8.6.3 Palatal implant 393

8.7 Tissue engineering by Dritan Turhani and Elisabeth Stein 396

8.7.1 Basic principles 396

8.7.2 Tissue engineering of bone 396

8.7.3 Tissue engineering with hydroxyapatite 397

8.8 Complications 400

8.8.1 Suture dehiscence 400

8.8.2 Nerve injuries 401

8.8.3 Mucosal complications 403

8.8.4 Peri-implantitis 407

References 414

J. Thomas Lambrecht

9 At-risk patients and emergencies 421

9.1 Cardiovascular diseases 424

9.1.1 Endocarditis 424

9.1.2 Coronary heart diseases 426

9.1.3 Arterial hypertension 428

9.2 Lung diseases 430

9.2.1 Bronchial asthma 430

9.2.2 Chronic obstructive pulmonary disease 430

9.2.3 Tuberculosis 430

9.3 Liver, kidneys and gastrointestinal tract 431

9.3.1 Liver diseases 431

9.3.2 Kidney diseases 431

9.3.3 Gastrointestinal diseases 431

9.4 Diabetes mellitus 432

9.5 Blood diseases 433

9.5.1 Hemorrhagic diathesis 433

9.5.2 Patients taking anticoagulants 434

9.6 Viral diseases 437

9.6.1 HIV infection 437

9.6.2 Hepatitis B infection 437

9.6.3 Hepatitis C infection 439

9.6.4 Herpes simplex virus 439

9.7 Allergies 440

9.8 Joint diseases 441

9.8.1 Rheumatoid arthritis 441

9.8.2 Joint prostheses in osteoarthritis 442

9.9 Neurological and mental illnesses 443

9.9.1 Neurological disorders 443

9.9.2 Mental illnesses 445

9.10 Pregnancy 447

9.10.1 Physiological changes 447

9.10.2 Changes in the orofacial area 447

9.10.3 Guidelines on dental treatment 447

9.10.4 Infections during pregnancy 448

9.11 Emergencies 449

9.11.1 Monitoring 449

9.11.2 Emergency equipment 450

9.11.3 Emergency measures 451

References 459

Appendix 465

Abbreviations 467

Acknowledgments and source of illustrations 468

Internet links 469

Index 472