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