As direct evidence of progression was not available, indirect evidence was used instead. The percentage bone loss/age was calculated as follows: 80% of alveolar bone loss on #3/44 years old = 1.82. Thus, grade C was assigned.
D. According to the latest 2017 World Workshop on the topic of peri‐implantitis [12,13], there is strong evidence indicating a higher risk of peri‐implantitis development in patients who have a history of periodontitis, poor oral plaque control, and lack of regular periodontal maintenance therapy after implant placement. Furthermore, patients with active periodontal diseases or deep periodontal pockets may be at greater risk of developing peri‐implant diseases than periodontally healthy patients [14,15]. Thus, prior to proceeding with dental implant therapy, clinicians should carefully examine the periodontal conditions carefully and ensure that the patient does not have any active periodontal diseases. Oral hygiene habits need to be developed and meticulous home care abilities should be achieved prior to dental implant planning [16].
E. Clinical signs of occlusal trauma are often overlooked by clinicians; however, the following findings can provide valuable diagnostic information and help formulate the proper treatment plan for patients. According to the 2017 World Workshop on Classification of Periodontal and Peri‐Implant Diseases and Conditions on the topic of occlusal trauma [17], the following list of clinical/radiographic indicators could help identify occlusal trauma: fremitus, progression of mobility, occlusal discrepancies, wear facets, tooth migration, fractured tooth, thermal sensitivity, discomfort/pain on chewing, widening PDL space, root resorption, and cemental tear (Figure 1.1.8). It is important to understand that occlusal trauma by itself does not initiate periodontitis; however, there is evidence suggesting that it alters progression of the disease when combined with dental plaque [18]. It is also important to perform proper occlusal analysis when performing regenerative periodontal surgery, as there evidence to support the view that tooth mobility plays a role in the regenerative outcome [19].
Figure 1.1.8 Cemental tear on tooth #24 resulting in localized alveolar bone loss and increase in mobility. Secondary occlusal trauma was noted during clinical evaluation.
Edentulous alveolar ridge width/height should be recorded during the initial comprehensive examination [20]. This would ensure proper execution of dental implant therapy (implant size selection, depth/angulation of implant fixture, distance between adjacent tooth and implant, prosthetic emergence profile, screw vs. cement retained prosthesis and prosthetic occlusal form).
Esthetic plastic periodontal therapy is also a component of periodontal specialty; therefore, proper documentation of the patient’s smile line (low, average, high) and gingival margin harmony plays a crucial role in treatment planning. When a patient presents with high smile line, it is important to determine the main causative reason (altered passive eruption, vertical maxillary excess, hypermobile lip or combination) [21,22].
Case 1.2 Dental Plaque‐Induced Gingivitis
CASE STORY
A 27‐year‐old Caucasian male presented with the chief complaint of “My gums bleed when I brush my teeth.” The patient noticed blood in the gingiva whenever he brushed or flossed (A). There had never been any swelling or pain associated with his gums, and the patient had never had an episode like this before. The patient claimed to brush his teeth once daily, and he flossed two to three times a wee k (B).
Figure 1.2.1 Preoperative presentation (frontal view).
Figure 1.2.2 Preoperative frontal view of maxillary anteriors.
Figure 1.2.3 Preoperative frontal view of mandibular anteriors.
LEARNING GOALS AND OBJECTIVES
To be able to diagnose gingivitis
To identify the possible etiology for the same condition and to address them
To understand the importance of oral hygiene in preventing gingivitis
Medical History
There were no significant medical problems. On questioning, the patient stated he was taking no medications and he had no allergies.
Review of Systems
Vital signsBlood pressure: 120/65 mmHgPulse rate: 72 beats/minute (regular)Respiratory rate: 15 breaths/minute
Social History
The patient did not drink alcohol. He did smoke (started at age 23 and currently smoked half a pack of cigarettes daily).
Extraoral Examination
No significant findings. The patient had no masses or swelling, and the temporomandibular joint was within normal limits.
Intraoral Examination
The soft tissues of the mouth (except gingiva) including the tongue appeared normal.
A gingival examination revealed a mild marginal erythema, with rolled margins and swollen papillae (Figures 1.2.1–1.2.3).
A hard tissue and soft tissue examination were completed (Figure 1.2.4) (F).
Occlusion