Oral and Maxillofacial Surgery, Medicine, and Pathology for the Clinician

Contributors xvii Preface xix Part I Basics 1 1 Patient Evaluation and Management of Medical Problems in the Oral Surgery Patient 3 Risk Assessment 3 Documentation 4 Management of Patients with Medical Problems 5 Cardiovascular Disease 6 Hypertension 6 Angina Pectoris 7 Myocardial Infarction 8 Stroke/Cerebrovascular Accident 9 Cardiac Arrhythmias 9 Heart Failure 10 Treatment Guidelines 10 Endocrine Disorders 11 Diabetes Mellitus 11 Thyroid Disease 12 Adrenal Insufficiency 13 Hepatic Disease 13 Renal Disease 15 Dialyzed Patients 15 Pulmonary Disease 15 Asthma 15 Chronic Obstructive Pulmonary Disease 15 Pregnancy 16 Conclusion 18 References 18 2 Risk Reduction Strategies 21 Methods of Risk Reduction 21 Faulty Record Keeping 21 Informed Consent 21 Conclusion 23 Reference 23 3 Preparing the Dental Office for Medical Emergencies: Essentials of an Emergency Kit 25 Staff 25 Equipment 26 Oxygen 26 Airway Adjuncts 26 Automated External Defibrillators (Figure 3.2) 26 Vitals Monitoring 27 Intravenous Kits 27 Emergency Drug Kit 27 Oxygen 27 Aromatic Ammonia 27 Aspirin 28 Albuterol 28 Glucose 28 Nitroglycerin 28 Diphenhydramine 29 Epinephrine 29 Sedation-Specific Emergencies 29 Summary 29 References 29 Part II Dentoalveolar Surgery 31 4 Surgical Management of the Impacted Canine 33 Etiology 33 Diagnosis 33 Treatment and Management of the Impacted Canine 35 Goals 35 Interceptive Treatment to Prevent Impactions 35 Surgical Management of the Impacted Canine 35 Open vs Closed Surgery 35 Palatal Maxillary Impactions 36 Labial Maxillary Impactions 36 Mandibular Impactions 37 Complications 37 References 38 5 Crown Lengthening 39 Biologic Width 39 Indications for Crown Lengthening [3] 39 Contraindications for Crown Lengthening [1] 40 Procedures Carried Out Prior to Crown Lengthening [4] 40 Bone Sounding [2] 40 Sequence of Treatment for Crown Lengthening 40 External Bevel Gingivectomy 40 Internal Bevel Gingivectomy 40 Flap Surgery with Osseous Surgery 41 Apically Positioned Flap With or Without Osseous Surgery 42 Combined with Orthodontic Extrusion 42 Classification of Esthetic Crown Lengthening [2] 42 Postoperative Care [3] 43 References 43 Part III Implantology 45 6 Bone-Grafting Techniques and Biomaterials for Alveolar Ridge Augmentation 47 Bone Graft Materials and Healing Physiology 47 Introduction 47 Bone Graft and Tissue Engineering Materials – Outline 47 Autogenous (Natural) 47 Allograft (Natural) 47 Xenograft – Bovine, Porcine, Equine, Marine Coral, or Algal Sources 47 Alloplast 47 Other Synthetic Sources (Engineered) 48 Autologous Platelet Concentrate 48 Bone Graft and Tissue Engineering Materials 48 Autograft 48 Allograft 48 Mineralized Freeze-Dried Bone Allograft 49 Demineralized Freeze-Dried Bone Allograft 49 Particulate Cortical, Cancellous, and Corticocancellous Allograft 49 Xenograft 49 Natural Hydroxyapatite 49 Bio-Oss – Bovine Derived 49 Natural Hydroxyapatite – Marine Coral Derived 49 Calcium Carbonate – Biocoral 49 Fluorohydroxyapatite (FHA) – Natural Sea Algae Derived 50 Alloplast (Synthetic Sources) 50 Hydroxyapatite Based (Synthetic HA) 50 Marine Coral Derived (Hydroxyapatite) 50 Coralline Porous Hydroxyapatite – Interpore (Synthetic HA) 50 Coralline Porous Hydroxyapatite – Pro Osteon (Synthetic HA) 50 Nanocrystalline Hydroxyapatite (Synthetic HA) 51 Tricalcium Phosphate (Synthetic) 51 Biphasic HA and B-TCP Material (Synthetic Combination) 51 Calcium Sulfate – Gypsum Based (Synthetic) 51 Calcium Sulfate – Nanocrystalline (Synthetic) 51 Biphasic Calcium Sulfate (Synthetic) 51 Bioactive Glass Ceramics (Synthetic) 52 Other Synthetic Sources – Recombinant Bone Morphogenetic Protein (rhBMP) 52 Autologous Platelet Concentrates (See Table 6.1 for Complete Formulations) 52 Platelet-Rich Plasma 52 Platelet-Rich Fibrin 52 Ridge Preservation 54 Ridge Preservation Indications 54 Ridge Preservation Algorithm 54 Ridge Preservation Surgical Technique 55 Ridge Preservation Surgical Complications 57 Ridge Preservation Implant Survival and Success Rates 57 Ridge Preservation Conclusion (Box 6.4) 58 Guided Bone Regeneration (GBR) 59 Guided Bone Regeneration Indications 59 Nonabsorbable Membrane 59 Titanium Mesh 59 e-PTFE [51, 52] 59 Nonexpanded d-PTFE (Osteogenics Biomedical) [6, 49–51, 53] 59 Titanium-reinforced PTFE [51, 54] 60 Absorbable Membrane 61 Collagen Base (Bovine, Porcine, or Human Tendon, Dermis, Skin, or Pericardium) 61 Polymeric Membrane (Manufactured Synthetic Membrane) 61 Tuberosity Harvest Technique (Figures 6.9–6.11, Box 6.5) 62 Guided Bone Regeneration 62 Surgical Technique for Three Wall Defect (Figures 6.15–6.18) 62 Surgical Technique for Moderate-to-Severe Defect 62 Particulate Graft Resorption Post Grafting 64 Guided Bone Regeneration Complications 65 Guided Bone Regeneration Implant Survival and Success Rates 65 Guided Bone Regeneration Conclusion (Box 6.6) 65 Intraoral Onlay Graft 66 Indications (Particulate and Block Graft) 66 Subperiosteal Tunneling Technique with Absorbable Membrane 67 Autogenous Onlay Corticocancellous Grafts Healing 68 Surgical Harvest Technique: Intraoral Lateral Ramal Shelf and Symphysis (Figure 6.8) 68 Autogenous Intraoral Block Grafts – Surgical Complications 70 Allogeneic Block Bone (Cadaver Bone) 70 Block Graft Implant Survival and Success Rate 70 Block Graft Conclusion (Box 6.7) 70 Ridge Split 71 Indications 71 Ridge Split Surgical Technique 71 Ridge Split Complications 71 Ridge Split Implant Survival and Success Rates 72 Ridge Split Conclusion (Box 6.8) 72 Interpositional Bone Graft or “Sandwich Osteotomy” 73 Indications 73 Interpositional Bone Graft Surgical Technique 73 Interpositional Bone Graft Complications 74 Interpositional Bone Graft Implant Survival and Success Rates 74 Interpositional Bone Graft Conclusion (Box 6.9) 74 Distraction Osteogenesis 75 Indications 75 Distraction Osteogenesis Surgical Technique 77 Distraction Osteogenesis Complications 77 Distraction Osteogenesis Implant Survival and Success Rates 77 Distraction Osteogenesis Conclusion (Box 6.10) 77 Postoperative Instructions 77 Conclusion 78 Horizontal Augmentation Recap (Tables 6.5 and 6.6) 78 Horizontal Augmentation Complication Recap 78 Vertical Augmentation Recap (Tables 6.5 and 6.6) 79 References 81 7 Maxillary Sinus Augmentation 85 Introduction 85 Maxillary Sinus Anatomy 85 Indications, Contraindications, Limitations 85 Lateral Window Approach 86 Transalveolar (Crestal) Approach 86 Bone-Grafting Material 87 Complications 87 References 89 8 Technologic, Material, and Procedural Advancements in Dental Implant Surgery 91 Introduction 91 Three-Dimensional Imaging 91 Computerized Implant Planning Technology 92 Intraoral Optical Impressions and Integration with CBCT, CAD/CAM, and Stereolithography 92 Surgical Drilling Guide Integration and Fabrication 94 Guided Navigation in Osteotomy Preparation and Implant Placement 94 Membranes for Bone Grafting 95 BMP, PRGF, and PRP 96 Implant-Supported, Full-Arch, Fixed Prostheses with Immediate Loading and “All-on-Four” 97 Zygomatic Implants 98 Lasers 99 Conclusion 100 References 100 Part IV Trauma 101 9 Diagnosis and Management of Dentoalveolar Trauma 103 Introduction 103 Evaluation 103 History 103 Physical Examination 103 Radiographic Studies 104 Diagnosis and Management of Dentoalveolar Injuries 104 Injuries to the Dental Hard Tissue and Pulp 104 Crown Infraction 104 Crown Fracture 104 Crown-Root Fracture 105 Root Fracture 105 Injuries to the Periodontal Tissues 105 Concussion 105 Subluxation 105 Intrusion 105 Extrusion 106 Lateral Luxation 106 Avulsion 106 Dentoalveolar Injuries in the Primary Dentition 107 Splinting 108 Injuries to the Gingiva or Oral Mucosa 108 Injuries to Supporting Bone 108 Follow-Up 109 Conclusion 109 References 109 Part V Pathology 113 10 Biopsy Technique: When, Where, and How? 115 Introduction 115 Patient Evaluation: Health History, Medications 115 Lesion History 116 Clinical Examination 117 Indications for Biopsies 120 Precancerous Lesion: “Potentially Malignant Disorders” 120 Biopsy Techniques 123 Incisional Biopsy 123 Excisional Biopsy 124 Punch Biopsy 124 Adjunctive Techniques 124 Lugol’s Iodine 126 Toluidine Blue 126 Brush Biopsy/Cytology 128 References 128 11 Diagnosis and Management of Recurrent Lesions of the Oral Mucosa 131 Introduction 131 Aphthous Lesions and Recurrent Aphthous Stomatitis 131 Presentation 131 Etiology 131 Diagnosis 132 Treatment 132 Herpetic Lesions 133 Course of the Disease 133 Diagnosis 133 Treatment 133 Candidiasis 134 Clinical Presentation 134 Diagnosis 134 Treatment 134 Lichen Planus 135 Clinical Presentation 135 Diagnosis 135 Treatment 135 Pemphigus Vulgaris 136 Clinical Presentation 136 Etiology 136 Diagnosis 137 Treatment 137 Erythema Multiforme 137 Clinical Presentation 137 Diagnosis 138 Treatment 138 Fixed Drug Eruptions 138 Clinical Presentation 138 Etiology 138 Diagnosis 139 Treatment 139 References 139 12 Benign Pediatric Pathology: Diagnosis and Management 143 Introduction 143 Eruption Cyst 144 Ameloblastoma 145 Aneurysmal Bone Cyst 146 Melanotic Neuroectodermal Tumor of Infancy 147 Juvenile Ossifying Fibroma 148 Cherubism 149 Hemangioma 150 Vascular Malformation 151 Verrucous Vulgaris and Condyloma Acuminatum 152 References 153 13 Diagnosis and Management of Salivary Gland Pathology 157 Introduction 157 Management of Sialolithiasis 158 Bacterial Salivary Gland Infections 159 Viral Sialadenitis 160 Granulomatous Disease of the Salivary Gland 160 Autoimmune Diseases 161 Warthin Tumor 162 Conclusion 163 References 163 14 Odontogenic Cysts and Odontogenic Tumors 167 Introduction 167 Developmental Odontogenic Cysts 168 Odontogenic Keratocyst (Keratocystic Odontogenic Tumor) 169 Lateral Periodontal Cyst and Botryoid Odontogenic Cyst 171 Gingival Cyst 172 Orthokeratinized Odontongenic Cyst 173 Ameloblastoma 174 Clinical Presentation 175 Histologic Features 176 Squamous Odontogenic Tumor 177 Histologic Features 178 Histologic Features 179 References 180 15 Osteomyelitis of the Jaw 183 Classification 183 Laboratory Analysis 184 Microbiology 186 Treatment 187 Case Presentations 188 Osteomyelitis of the Maxilla 188 Osteomyelitis of the Mandible 189 References 192 16 Obstructive Sleep Apnea 193 Introduction 193 Symptoms 194 Surgical Procedures 195 Uvulopalatopharyngoplasty 196 Genial Tubercle Advancement 197 Conclusion 198 References 198 17 Temporomandibular Disorders: A Clinician’s Guide for Nonsurgical and Surgical Interventions 201 Introduction 201 Nonsurgical Treatment Approaches 204 Methods of Therapy 205 Maxillary and Mandibular Full-Arch Splints 206 Surgical Approaches 207 Case Presentation 214 Conclusion 216 References 216 18 Postoperative Complications in Oral Surgery 219 Complications Arising During the Procedure 219 Root Fracture and Displacement 220 Nerve Injury 221 Complications after Oral Surgery 222 Infection 223 Pain, Swelling, and Trismus 224 References 225 19 Odontogenic Infections: Anatomy, Etiology, and Treatment 227 Introduction 227 Physical Examination 228 Radiographic Imaging 229 Pain Control 230 Treatment Techniques 231 Method 231 Palatal Abscess 232 Method 233 Buccal and Midfacial Abscess 234 Method 235 Methods 236 Pterygomandibular Space 237 Pericoronitis 238 Antibiotic Therapy 239 References 240 Part VI Pain Control 243 20 Approaches to the Management of Facial Pain 245 Introduction 245 Diagnostic Approach to Facial Pain Patients 246 Neuropathic Pain 248 Episodic Neuropathic Pain 249 Continuous NP 250 Neurovascular Pain 253 Topical NSAIDs 254 Injection Therapy 255 Complications of Injection Therapy 256 Summary and Future Directions 257 References 257 21 Local Anesthesia: Agents and Techniques 261 Local Anesthetics 261 Nerve Block Techniques 262 Greater Palatine Approach 263 Sigmoid Notch Approach 264 Halstead Method 265 Akinosi Technique (Figure 21.6) 266 Auxilliary/Supplemental Techniques 267 Intrasulcular Infusion 268 Trigger Point Injections 270 Nasal Spray 271 References 272 22 Nitrous Oxide 275 History 275 Use and Administration 275 Contraindications 276 Safety Mechanisms 277 References 278 Part VII Oral Medicine 281 23 Antibiotic Prophylaxis in Oral and Maxillofacial Surgery: Recent Trends in Therapeutic Applications 283 Introduction 283 Infective Endocarditis 285 Additional Considerations about Infective Endocarditis Antibiotic Prophylaxis (When Indicated) 286 Third Molars/Extractions 287 Cleft lip and palate 289 Dental Implants 290 Trauma 291 Conclusion 292 References 292 24 Management of Patients on Anticoagulation 295 Introduction 295 Heparins 296 Antiplatelet Agents 297 Conclusion 299 References 299 25 Burning Mouth Syndrome 301 Introduction 301 Etiology and Risk Factors 302 Diagnosis 303 Treatment 304 Primary Burning Mouth Syndrome 305 Conclusion 306 References 307 Index 311