Diseases and Conditions in Dentistry

The author Keyvan Moharamzadeh, BSc, DDS, PhD, FHEA, FDSRCS, is a Senior Clinical Lecturer and Honorary Consultant in Restorative Dentistry and Specialist in Prosthodontics, Periodontics, Endodontics and Restorative Dentistry, at the University of Sheffield, UK.

Contents

Preface xxi

Acknowledgements xxiii

Image Contributors xxv

Abbreviations xxvii

About the Companion Webstite xxix

1 Aggressive Periodontitis 1

1.1 Definition  1

1.1.1 Primary Features 1

1.1.2 Secondary Features 1

1.2 Classification  1

1.3 Prevalence 1

1.4 Aetiology and Pathogenesis 1

1.4.1 Bacteria 2

1.4.2 Genetic Susceptibility  2

1.4.3 Smoking 2

1.5 Screening  2

1.6 Diagnosis 2

1.7 Prognosis 2

1.8 Treatment 2

1.8.1 Systemic Antibiotics  3

1.8.2 Local Antimicrobials  3

References  8

2 Amelogenesis Imperfecta 11

2.1 Definition  11

2.2 Aetiology 11

2.3 Epidemiology 11

2.4 Classification  11

2.5 Diagnostic Clinical Features 11

2.5.1 Hypoplastic Type 11

2.5.2 Hypocalcified Type 11

2.5.3 Hypomaturation Type 11

2.6 Relevant History 12

2.7 Relevant Investigations 12

2.8 Prognosis  12

2.9 Treatment Considerations  12

2.9.1 Management of Children  12

2.9.2 Mixed Dentition  13

2.9.3 Permanent Dentition  13

2.9.4 Adulthood 13

2.10 Survival of Restorations 13

References  18

3 Apical Periodontitis 19

3.1 Definitions and Classification 19

3.2 Relevant Anatomy 19

3.3 Immunopathology 19

3.4 Aetiology 20

3.5 Microbiology  20

3.6 Radiology 21

3.7 Diagnosis 21

3.8 Epidemiology 23

3.9 Endodontic Treatment Considerations  23

3.9.1 Local Anaesthesia  23

3.9.2 Isolation and Disinfection  23

3.9.3 Access Cavity Preparation 23

3.9.4 Magnification  23

3.9.5 Working Length Determination  23

3.9.6 Root Canal Preparation Techniques  24

3.9.7 Irrigation and Debridement 24

3.9.8 Interappointment Medication  24

3.9.9 Obturation Techniques  24

3.9.10 Coronal Restoration  25

3.9.11 Review 25

3.9.12 Exacerbation  25

3.10 Endodontic Retreatment  25

3.11 Prognosis and Outcome of Non-Surgical Endodontic Treatment  26

3.11.1 Preoperative Factors  26

3.11.2 Intraoperative Factors  26

3.11.3 Post-Treatment Factors 26

3.12 Surgical Endodontic Treatment  26

3.12.1 Indications  26

3.12.2 Contraindications  26

3.12.3 Flap Design 27

3.12.4 Specific Anatomy  27

3.12.5 Bone Removal  27

3.12.6 Root End Preparation  27

3.12.7 Root End Filling 27

3.12.8 Prognosis and Outcomes  27

3.12.8.1 Preoperative Factors  28

3.12.8.2 Intraoperative Factors  28

References  29

4 Bisphosphonates and Medication-Related Osteonecrosis of the Jaw 33

4.1 Definition and Staging 33

4.2 Pathogenesis 33

4.3 Prevalence 33

4.4 Prevention  34

4.5 Assessment and Investigations 34

4.6 Treatment Considerations  34

References  36

5 Caries 37

5.1 Definition and Aetiology 37

5.2 Pathogenesis 37

5.3 Epidemiology 37

5.4 Classification  37

5.5 Relevant History 38

5.6 Clinical Examination of Caries 38

5.7 Differential Diagnosis 38

5.8 Prevention  38

5.8.1 Tooth Brushing and Mechanical Plaque Control  38

5.8.2 Diet 38

5.8.3 Fluoride 38

5.8.4 Fissure Sealing 39

5.9 Treatment Considerations  39

5.9.1 Primary Teeth  39

5.9.2 Permanent Teeth 39

5.9.2.1 Minimally Invasive Techniques 39

5.9.2.2 Treatment of Exposed Pulp in Permanent Teeth  40

References  41

6 Chronic Periodontitis  45

6.1 Definition and Classification 45

6.2 Clinical Features and Characteristics  45

6.3 Periodontal Indices  45

6.4 Epidemiology 47

6.5 Risk Factors  47

6.5.1 Local Risk Factors  47

6.5.2 Systemic Risk Factors  47

6.5.2.1 Smoking Tobacco  47

6.5.2.2 Diabetes  47

6.5.2.3 Genetics 48

6.5.2.4 Osteoporosis  48

6.5.2.5 Psychosocial Factors  48

6.5.2.6 Other Considerations  48

6.6 Microbiology  48

6.7 Pathogenesis 49

6.8 Role of Occlusal Trauma  49

6.9 Treatment 50

6.9.1 Treatment Goals  50

6.9.2 Treatment Phases  50

6.9.2.1 Systemic Phase  50

6.9.2.2 Initial Hygiene Phase 50

6.9.2.2.1 Mechanical Supragingival Plaque Control 50

6.9.2.2.2 Chemical Supragingival Plaque Control 51

6.9.2.3 Non-Surgical Therapy  51

6.9.2.3.1 Management of Tooth Mobility  52

6.9.2.4 Corrective Phase (Additional Therapy) 52

6.9.2.4.1 Periodontal Surgery 52

6.9.2.4.2 Outcome of Periodontal Surgery  53

6.9.2.4.3 Treatment of Teeth with Furcation Involvement  53

6.9.2.4.4 Periodontal Regeneration 54

6.9.2.5 Maintenance Phase  55

References  58

7 Cleft Lip and Palate 63

7.1 Introduction  63

7.2 Complications  63

7.3 Dental Abnormalities  63

7.4 Management of Patients with CLP  63

7.4.1 Infancy and Primary Dentition Stage 64

7.4.2 Mixed Dentition  64

7.4.3 Permanent Dentition  64

7.4.3.1 Orthodontic Treatment  64

7.4.3.2 Orthognathic Surgery  64

7.4.3.3 Distraction Osteogenesis (DO)  64

7.4.3.4 Restorative Treatment  65

References  67

8 Combination Syndrome 69

8.1 Defining Features 69

8.2 Pathogenesis 69

8.3 Clinical Assessment  69

8.4 Prevention  70

8.5 Treatment Considerations  70

8.6 Management of Flabby Ridge 70

8.7 Management of Denture-Induced Stomatitis  71

References  72

9 Complete Edentulism 75

9.1 Introduction  75

9.2 Treatment Stages  75

9.3 Denture Support  75

9.4 Challenging Conditions 75

9.5 Complete Denture Occlusion  76

9.5.1 Measuring Occlusal Vertical Dimension (OVD) 76

9.5.2 Registration of Centric Relation (CR)  76

9.5.3 Complete Denture Occlusal Schemes  76

9.5.3.1 Bilateral Balanced Occlusion  76

9.5.3.2 Monoplane Scheme of Occlusion  77

9.5.3.3 Linear Occlusion Scheme  77

9.5.4 Occlusal Adjustment  77

9.6 Setting Up the Teeth in Complete Denture  77

9.7 Tooth Size and Shape  78

9.8 Soft Liners and Tissue Conditioners 78

9.9 Copy Denture 78

9.10 Complete Denture Troubleshooting  79

References  81

10 Deep Overbite 83

10.1 Definition and Prevalence 83

10.2 Aetiology 83

10.3 Classification  83

10.4 Treatment Options  83

10.4.1 Orthodontic Treatment  83

10.4.2 Orthognathic Surgery  84

10.4.3 Prosthodontic and Restorative Treatment  84

References  86

11 Dens Invaginatus  87

11.1 Definition and Terminology 87

11.2 Aetiology and Prevalence 87

11.3 Classification  87

11.4 Clinical Examination and Investigations 87

 11.5 Treatment Considerations  88

References  90

12 Dentine Hypersensitivity 93

12.1 Definition  93

12.2 Prevalence 93

12.3 Aetiology and Pathogenesis 93

12.4 History and Examination 93

12.5 Management  94

12.5.1 Management of DHS in Patients with Gingival Recession and/or Periodontal Disease 94

12.5.2 Management of DHS in Patients with Tooth Surface Loss  94

References  96

13 Dentinogenesis Imperfecta and Dentine Dysplasia 99

13.1 Definition  99

13.2 Classification and Clinical Features 99

13.3 Aetiology and Pathogenesis 99

13.4 Epidemiology 100

13.5 Differential Diagnoses 100

13.6 Relevant History and Special Investigations 100

13.7 Treatment Considerations  100

13.7.1 Primary Dentition  100

13.7.2 Permanent Dentition  101

References  104

14 Dentoalveolar Trauma 105

14.1 Introduction  105

14.2 Displaced and Malpositioned Teeth 105

14.3 Loss of Vitality and Discolouration 105

14.4 Ankylosis and Root Resorption 106

14.5 Lost Teeth 106

14.5.1 Exodontia Considerations  106

14.5.2 Role of Orthodontists  106

14.5.3 Autotransplantation  106

14.5.4 Prosthetic Tooth Replacement  107

References  113

15 Discolouration 115

15.1 Introduction  115

15.2 Intrinsic Discolouration  115

15.2.1 Alkaptonuria 115

15.2.2 Congenital Hyperbilirubinaemia 115

15.2.3 Congenital Erythropoietic Porphyria 115

15.2.4 Tetracycline Staining  115

15.2.5 Pulpal Disease 115

15.2.6 Root Resorption  116

15.2.7 Amelogenesis Imperfecta (AI) 116

15.2.8 Dentinogenesis Imperfecta (DI)  116

15.2.9 Fluorosis  116

15.2.10 Ageing 116

15.2.11 Other Conditions Associated with Enamel Defects 116

15.3 Extrinsic Discolouration  116

15.4 Treatment Options  116

15.5 Tooth Bleaching  117

15.5.1 Bleaching Techniques  117

15.5.1.1 Vital Bleaching (External Bleaching)  117

15.5.1.2 Non‐Vital Bleaching (Internal Bleaching)  117

15.5.1.3 Inside/Outside Bleaching  117

15.5.2 Bleaching Products  117

15.5.2.1 Whitening Gels  117

15.5.2.2 Whitening Strips  117

References  118

16 Ectodermal Dysplasia 121

16.1 Definition and Prevalence 121

16.2 Classification  121

16.3 Aetiology 121

16.4 Diagnosis and Clinical Features 121

16.5 Management Considerations  122

16.6 Restorative Treatment  122

16.6.1 Direct Restorations  122

16.6.2 Indirect Restorations  122

16.6.3 Removable Dentures 122

16.6.4 Implants  122

References  124

17 External Root Resorption 127

17.1 Introduction  127

17.2 Aetiology and Pathogenesis 127

17.3 External Invasive Cervical Root Resorption 127

17.4 History and Examination 128

17.5 Differential Diagnosis 128

17.6 Treatment Considerations  128

17.6.1 Non‐Surgical Management  128

17.6.2 Surgical Management  129

17.6.3 Endodontic Treatment  130

References  131

18 Failed Restoration and Compromised Tooth 133

18.1 Introduction  133

18.2 Direct Restorations  133

18.2.1 Amalgam Restorations 133

18.2.2 Composite Restorations  133

18.2.3 GIC, Resin‐Modified GIC and Compomers  134

18.3 Indirect Restorations  134

18.3.1 Crowns  134

18.3.1.1 Porcelain Fused to Metal (PFM) Crowns  135

18.3.1.2 All‐Ceramic Crowns  135

18.3.1.3 Full Gold Crowns (FGG)  135

18.3.2 Inlays and Onlays 135

18.3.3 Veneers  136

18.4 Restoration of Root‐Treated Teeth  136

References  140

19 Fluorosis 143

19.1 Definition  143

19.2 Aetiology and Pathogenesis 143

19.3 Prevalence  143

19.4 Clinical Features and Classifications 143

19.5 Diagnosis 143

19.6 Treatment Considerations  144

References  146

20 Fractured Endodontic Instrument  147

20.1 Incidence 147

20.2 Causative Factors and Prevention 147

20.3 Impact on Outcome of Endodontic Treatment  147

20.4 Management Strategies  148

20.5 Factors Affecting Removal of Fractured Instruments 148

20.6 Fragment Removal 149

References  151

21 Fractured or Failed Post  153

21.1 Introduction  153

21.2 Reasons for Failure of Post‐Retained Restorations 153

21.3 Factors to Consider  153

21.4 Risks of Post Removal 153

21.5 Post Removal Techniques  154

References  157

22 Gingival Enlargement and Gingivitis 159

22.1 Introduction  159

22.2 Aetiology and Clinical Features 159

22.3 Diagnosis 160

22.4 Management  160

References  164

23 Gingival Recession 165

23.1 Introduction  165

23.2 Aetiology and Risk Factors 165

23.3 Classification  166

23.4 Diagnosis 166

23.5 Prevention and Non‐Surgical Management 166

23.5.1 Monitoring and Maintenance  166

23.5.2 Adhesive Restorations 166

23.5.3 Gingival Prosthesis 166

23.5.4 Orthodontic Space Closure  167

23.6 Surgical Treatment  167

23.6.1 Gingival Augmentation 167

23.6.2 Surgical Root Coverage 168

23.6.2.1 Pedicle Soft Tissue Grafts  168

23.6.2.2 Free Soft Tissue Grafts  169

23.6.2.3 Prognostic Factors  169

23.6.2.4 Clinical Outcome of Various Root Coverage Procedures 170

23.6.3 Surgical Reconstruction of Interdental Papillae 170

23.6.4 Periodontal Microsurgery 170

References  173

24 Halitosis 177

24.1 Terminology  177

24.2 Aetiology 177

24.3 Epidemiology 177

24.4 Classification  177

24.5 Diagnosis 177

24.6 Management Strategies  178

References  179

25 Hypodontia  181

25.1 Definition and Classification 181

25.2 Aetiology 181

25.3 Epidemiology 181

25.4 Clinical Features  181

25.5 History and Examination 182

25.6 Relevant Investigations 182

25.7 Care Pathway 182

25.8 Multidisciplinary Team 182

25.9 Restorative Considerations 183

25.10 Treatment Considerations  183

25.10.1 Preventive Care 183

25.10.2 Treatment Options for Missing Teeth  183

25.10.3 Missing Maxillary Lateral Incisors 183

25.10.3.1 Space Closure  183

25.10.3.2 Space Opening  184

25.10.4 Missing Mandibular Incisor Teeth  184

25.10.5 Maxillary Midline Diastema 184

25.10.6 Management of Retained Primary Teeth  184

25.10.7 Prosthetic Options to Replace the Missing Teeth 185

25.10.7.1 Resin-bonded Bridge (RBB)  185

25.10.7.2 Conventional Bridge 186

25.10.7.3 Removable Partial Denture (RPD) and Overdenture 186

25.10.7.4 Implant‐Retained Prosthesis  186

25.10.8 General Maintenance Requirements  187

References  191

26 Internal Root Resorption 193

26.1 Definition  193

26.2 Pathogenesis  193

26.3 Predisposing Factors 193

26.4 Epidemiology 193

26.5 Classification  193

26.6 Diagnosis 193

26.6.1 Clinical Features  194

26.6.2 Radiographic Features 194

26.7 Treatment Considerations  194

References  196

27 Irrigation Accidents 197

27.1 Introduction  197

27.2 Types of Incidents and Common Causes 197

27.3 Signs and Symptoms 197

27.4 Prevention  197

27.5 Management  198

References  200

28 Low Maxillary Sinus Floor 201

28.1 Introduction  201

28.2 Sinus Floor Elevation Techniques  201

28.2.1 Lateral Approach  201

28.2.1.1 Indications and Contraindications  201

28.2.1.2 Preoperative Assessment 201

28.2.1.3 Surgical Approach 202

28.2.1.4 Bone Grafting  202

28.2.1.5 Postoperative Care and Complications 203

28.2.2 Crestal Approach  203

28.3 Implant Survival 203

References  204

29 Microdontia  207

29.1 Definition, Prevalence and Classification 207

29.2 Aetiology 207

29.3 Examination and Diagnosis 207

29.4 Management  207

References  210

30 Necrotising Periodontal Diseases 211

30.1 Introduction  211

30.2 Epidemiology 211

30.3 Predisposing Factors 211

30.4 Clinical Features and Diagnosis 211

30.5 Microbiology and Histology 211

30.6 Management  212

30.6.1 Acute Phase Treatment  212

30.6.2 Treatment of Chronic Periodontal Disease  212

30.6.3 Corrective Phase Treatment  212

30.4 Maintenance  212

References  213

31 Occlusal Issues and Occlusion 215

31.1 Definitions  215

31.2 Occlusal Philosophies 215

31.3 Assessment and Recording of Occlusion 216

31.4 Articulators  216

31.5 Face‐bow  216

31.6 Conformative Approach 217

31.7 Reorganisation of Occlusion  217

31.8 Determinants of Posterior Occlusal Morphology 217

References  219

32 Oncology‐Related Defects in Mandible 221

32.1 Introduction  221

32.2 Roles of the Multidisciplinary Team in Head and Neck Cancer Management 221

32.3 Consequences of Cancer Surgery in Mandible 222

32.4 Classification of Mandibular Defects 222

32.5 Rehabilitation of Mandibular Defects 222

32.5.1 Surgical Reconstruction of Mandibular Defects 222

32.5.2 Prosthetic Rehabilitation of Mandibular Defects  223

32.5.2.1 Pretherapy Dental Screening  223

32.5.2.2 Prosthetic Challenges  223

32.5.2.3 Conventional Prosthetic Management  224

32.5.2.4 Implants in Oncology Patients  224

32.5.2.4.1 Indications and Limitations  224

32.5.2.4.2 Relevant History and Preoperative Examination 224

32.5.2.4.3 Planning, Timing and Design Considerations 225

32.5.2.4.4 Primary Implants  225

32.5.2.4.5 Implants in Irradiated Bone  225

32.5.2.4.6 Implants in Grafted Bone Flaps  225

References  229

33 Oncology‐Related Defects in Maxillae 233

33.1 Maxillary Tumours  233

33.2 Surgical Resection  233

33.3 Classification of Maxillary Defects 233

33.4 Surgical Reconstruction  234

33.4.1 Local and Regional Flaps 234

33.4.2 Soft Tissue Free Flaps  234

33.4.3 Hard Tissue or Composite Free Flaps 234

33.5 Prosthetic Treatment 234

33.6 Alterations at Surgery to Facilitate Prosthetic Treatment  234

33.7 Prosthetic Treatment Phases  235

33.7.1 Surgical Obturator  235

33.7.2 Interim Obturator  235

33.7.3 Definitive Obturator  236

33.8 Soft Palate Defects  236

33.9 Osseointegrated Implants  236

References  238

34 Open Apex (Immature Non‐Vital Teeth) 241

34.1 Definition  241

34.2 Aetiology 241

34.3 Classification  241

34.4 Management Strategies  241

34.4.1 Working Length Determination in Teeth with Open Apices  241

34.4.2 Irrigation Considerations  241

34.4.3 Calcium Hydroxide Apexification 242

34.4.4 Placement of an Apical Plug to Create an Artificial Apical Barrier 242

34.4.4.1 Mineral Trioxide Aggregate 242

34.4.4.2 Biodentine®  242

34.4.5 Regenerative Endodontic Treatment  242

References  244

35 Open Bite 247

35.1 Definition and Classification 247

35.2 Aetiology 247

35.3 Incidence 247

35.4 Indications for Treatment  247

35.5 Treatment Options  247

35.5.1 Prevention  247

35.5.2 Orthodontic Treatment  247

35.5.3 Orthognathic Surgery  248

35.5.4 Restorative Treatment  248

References  250

36 Osteoradionecrosis 251

36.1 Definition and Pathogenesis 251

36.2 Prevalence  251

36.3 Risk Factors  251

36.4 Classification of ORN  251

36.5 Diagnosis 252

36.6 Prevention  252

36.6.1 Pre‐Radiotherapy Dental Assessment and Extractions 252

36.6.2 Patient Education  252

36.6.3 Minimising Trauma  252

36.6.4 Prophylactic Hyperbaric Oxygen Therapy and Antibiotics 252

36.7 Management  253

References  254

37 Partial Edentulism – Implant Treatment 257

37.1 Introduction  257

37.2 Preoperative Patient Assessment 257

37.2.1 History  257

37.2.2 Clinical Examination  257

37.2.3 Special Investigations 257

37.3 Risk Factors  258

37.3.1 Local Risk Factors  258

37.3.2 Systemic Risk Factors  258

37.3.3 Behavioural Risk Factors 259

37.4 Risk Assessment and Patient Consent 259

37.5 Treatment Considerations  259

37.5.1 Planning Stage 259

37.5.2 Surgical Stage  260

37.5.3 Prosthetic Treatment 260

37.5.4 Replacement of the Anterior Teeth with Implants  261

37.5.5 Replacement of the Posterior Teeth with Implants  261

37.5.6 Considerations in Bruxist Patients  261

37.5.7 Maintenance  262

37.5.8 Implant Complications  262

37.5.8.1 Biological Complications  262

37.5.8.1 Mechanical Complications  262

37.5.8.1 Aesthetic Complications  263

37.5.8.1 Evidence  263

37.6 Implant Survival 263

37.6.1 Implant‐Retained Single Crowns 263

37.6.2 Implant‐Retained Bridge  263

37.7 Timing of Implant Placement after Tooth Extraction  263

37.8 Timing of Implant Loading 264

References  269

38 Partial Edentulism – Partial Denture Treatment  273

38.1 Introduction  273

38.2 Removable Partial Denture Types 273

38.2.1 Acrylic Dentures  273

38.2.2 Cobalt-Chromium RPDs  273

38.2.3 Flexible Dentures  274

38.2.4 Hypoallergenic Dentures 274

38.2.5 PEEK‐based RPDs 274

38.3 Classification of Partially Dentate Arches 274

38.4 General Guidelines  274

38.5 RPD Design  274

38.5.1 Surveying 274

38.5.2 Occlusal Analysis 274

38.5.3 Replacing Anterior Teeth  274

38.5.4 Milled Crowns 275

38.5.5 Components of RPD Design 275

38.5.6 Saddle Areas 275

38.5.7 Rests  275

38.5.8 Retentive Clasps 275

38.5.9 Indirect Retainer  275

38.5.10 Mandibular Major Connectors  275

38.5.11 Maxillary Major Connectors  276

38.5.12 Minor Connectors  276

38.6 Swing‐Lock RPD  276

References  278

39 Perforation 281

39.1 Definition 281

39.2 Causes  281

39.3 Pathogenesis  281

39.4 Epidemiology 281

39.5 Classification  281

39.6 Diagnosis 281

39.7 Prognosis  282

39.8 Management  282

39.8.1 Extraction 282

39.8.2 Non‐Surgical Treatment  282

39.8.3 Surgical Treatment  282

39.9 Treatment Outcomes 283

References  285

40 Peri‐Implant Diseases 287

40.1 Definitions  287

40.2 Aetiology 287

40.3 Risk Factors  287

40.4 Prevalence  287

40.5 Diagnostic Criteria  287

40.6 Patient Assessment  288

40.6.1 Implant Identification  288

40.6.2 Relevant History 288

40.6.3 Assessment of Suprastructure 288

40.6.4 Assessment of Individual Fixtures 288

40.6.5 Assessment of Peri‐Implant Soft Tissue  288

40.6.6 Radiographic Assessment 288

40.7 Management of Peri‐Implant Mucositis  288

40.8 Management of Peri‐Implantitis  288

References  291

41 Periodontal Abscess 293

41.1 Definition and Classification 293

41.2 Pathogenesis  293

41.3 Prevalence  293

41.4 Microbiology  293

41.5 Diagnosis 293

41.6 Differential Diagnosis 294

41.7 Treatment 294

References  296

42 Periodontic‐Endodontic Lesion 297

42.1 Definition and Classification 297

42.2 Diagnosis 297

42.3 Prognosis  297

42.4 Management  298

References  300

43 Periodontitis as a Manifestation of Systemic Disease 301

43.1 Introduction  301

43.2 Periodontitis Associated with Haematological Disorders 301

43.3 Periodontitis Associated with Genetic Disorders 301

43.4 Periodontitis Associated with Other Conditions (Not Otherwise

Specified Group)  303

References  305

44 Radiotherapy Side Effects 307

44.1 Introduction  307

44.2 Radiation‐Induced Oral Mucositis  307

44.3 Xerostomia 308

44.3.1 Organ‐Sparing Radiotherapy 308

44.3.2 Salivary Gland Tissue Transfer 308

44.3.3 Preventive Medication 308

44.3.4 Salivary Stimulation 308

44.3.5 Saliva Substitution 308

44.4 Oral Infections  308

44.5 Trismus (Restricted Mouth Opening)  309

References  311

45 Ridge Defects (Generalised) 313

45.1 Introduction  313

45.2 Classifications  313

45.3 Neutral Zone Impression Technique for Resorbed Ridges 313

45.4 Magnet‐Retained Conventional Overdenture 314

45.5 Implant‐Supported Overdentures 314

45.6 Full‐Arch Implant‐Retained Fixed Prosthesis 315

References  317

46 Ridge Defects (Localised) 319

46.1 Introduction  319

46.2 Ridge Augmentation by Soft Tissue Grafts 319

46.3 Ridge Augmentation with Hard Tissue Surgery 320

46.3.1 Anatomical Repositioning Techniques 320

46.3.2 Bone Grafting  320

References  324

47 Shortened Dental Arch (SDA) 325

47.1 Definition  325

47.2 History  325

47.3 Effect of SDA on Oral Health‐Related Quality of Life 325

47.4 Effect of Tooth Loss on Masticatory Function  325

47.5 Effect of SDA on Occlusal Stability  325

47.6 Effect of SDA on Temporomandibular Joint  326

47.7 Alternative Treatment Options  326

References  327

48 Supernumerary, Fusion and Gemination 329

48.1 Supernumerary (Hyperdontia) 329

48.1.1 Prevalence  329

48.1.2 Classification  329

48.1.3 Aetiology 329

48.1.4 Oral and Dental Complications  329

48.1.5 Examination and Diagnosis 329

48.1.6 Management  330

48.2 Fusion  330

48.2.1 Classification  330

48.2.2 Aetiology 330

48.2.3 Incidence 330

48.2.4 Relevant Investigations 330

48.2.5 Treatment Options  330

48.3 Gemination  331

References  332

49 Temporomandibular Disorders 335

49.1 Definition  335

49.2 Prevalence  335

49.3 Classification  335

49.4 Aetiology 335

49.5 Diagnosis 336

49.6 Special Investigations 336

49.7 Management  336

49.7.1 Patient Education  336

49.7.2 Jaw Exercise and Manual Therapy 336

49.7.3 Acupuncture  336

49.7.4 Pharmacotherapy  337

49.7.5 Occlusal Stabilising Splint Therapy  337

49.7.6 Anterior Repositioning Splint 337

49.7.7 Occlusal Adjustment  337

49.7.8 TMJ Lavage  337

49.7.9 Surgery 337

References  338

50 Tooth Wear 341

50.1 Definitions and Clinical Features 341

50.2 Aetiology 341

50.2.1 Parafunction and Occlusion  341

50.2.2 Intrinsic Acids  341

50.2.3 Extrinsic Acids  342

50.3 Prevalence  342

50.4 Classification  342

50.5 History and Examination 343

50.6 Prevention  343

50.7 Management of Worn Teeth  343

50.7.1 Conformative Approach 343

50.7.2 Reorganisation Approach 343

50.7.3 Occlusal Splint Therapy Prior to VD Increase  344

50.7.4 Fixed Restorations  344

50.7.4.1 Direct Fixed Restorations  344

50.7.4.2 Indirect Fixed Restorations  344

50.7.5 Crown Lengthening 345

50.7.6 Removable Treatment Options  345

50.7.7 Maintenance  346

References  350

Index 355