Evidence-Based Periodontal and Peri-Implant Plastic Surgery A Clinical Roadmap from Function to Aesthetics Leandro Chambrone Editor 123 Evidence-Based Periodontal and Peri-Implant Plastic Surgery Leandro Chambrone Editor Evidence-Based Periodontal and Peri-Implant Plastic Surgery A Clinical Roadmap from Function to Aesthetics Editor Leandro Chambrone Unit of Basic Oral Investigation (UIBO) School of Dentistry, El Bosque University Bogota Colombia Department of Periodontics College of Dentistry, The University of Iowa Iowa City USA ISBN 978-3-319-13974-6 ISBN 978-3-319-13975-3 (eBook) DOI 10.1007/978-3-319-13975-3 Library of Congress Control Number: 2015937187 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) Foreword 1 D evelopments in biomedical sciences, the steadily accelerating advances in scientifi c knowl- edge, and the dizzying acquisition of new technologies would make it seem that the traditional format of a treatise or atlas would be outdated because of new digital means of communica- tion. This is not always true. Indeed, the new book, E vidence-Based Periodontal and Peri- Implant Surgery: A Clinical Roadmap from Function to Aesthetics by Professor Leandro Chambrone, is destined to become an irreplaceable tool for study, for critical assessments, and for furthering knowledge about the advances in the rapidly advancing domain of mucogingival plastic surgery. The author and his Latin American colleagues—all acknowledged leaders in the fi eld—have tackled this important branch of periodontology, focusing attention on the management of soft tissues surrounding teeth and implants to achieve signifi cantly positive clinical–aesthetic results. It is with great scientifi c precision and emphasis on the current philosophy of evidence- based medicine that the fi rst six chapters deal with the biological and anatomical–physiologi- cal principles at the base of every surgical procedure. Indications for surgery, operating techniques, limitations, and potential complications are described in detail for various clinical situations such as gingival recessions, tissue augmentation procedures, and crown lengthening. Chapters 7 and 8 are particularly interesting as they offer suggestions for the multidisciplinary construction of decision trees in clinical practice. T he texts are enriched by splendid illustrations. The techniques are explained in detail with the help of exceptionally clear diagrams and drawings, and the bibliography is as complete as it is concise. This book/atlas is a highly recommendable and extremely readable tool not only for expe- rienced periodontal surgeons but also for students and recent dental school graduates. The book, which is invaluable in itself, refl ects the professionalism, vast cultural back- ground, and exceptional preparation of Professor Chambrone, an indefatigable researcher whom all members of the dentistry and oral surgery communities know and admire. My compliments go to the author and his staff also for the beautiful presentation of this book. v vi Foreword 1 I would like to extend heartfelt best wishes to my friend Leandro and his colleagues: They will certainly be rewarded for the enormous effort they put into this book/atlas—una opera d’arte! Florence, Italy Giovanpaolo Pini Prato Foreword 2 T his complete periodontal textbook has compiled information enabling the reader to clearly understand the complex discipline of periodontal plastic surgery. A signifi cant portion of the world’s population has demonstrated susceptibility to aesthetic and/or functional problems involving the mucogingival complex and required professional attention. The book provides appropriate and up-to-date information concerning the diagnosis, the therapeutics available to control the condition, and the importance of long-term maintenance. The capabilities of the periodontist to guide patients in a constructive fashion predictably results in the maintenance of the natural dentition, which most people prefer. This, of course, takes account of the predictability of osseointegrated implants. T he author has presented an understanding of the disease/condition process that can be applied in any dental offi ce. It provides a thorough opportunity to familiarize the reader with the methods of therapy and the limitations that can be achieved. There is a remarkable section of the textbook demonstrating step-by-step surgical procedures of benefi t to the patient. A signifi cant portion is dedicated to mucogingival surgery; a most common reason for many patients to visit a periodontist is their recognition of gingival recession. The author has pro- vided insight into incision design, fl ap management, and selection of the appropriate proce- dure. The successful outcome of any treatment regime requires attention to a series of patient-related issues, sound knowledge of the anatomy, and surgical training, which are pre- requisites for predictable results. The predictability of periodontal regeneration has developed over the past decades and is greatly infl uenced by the recognition of which strategic tooth can be saved and which bioma- terials can provide the best result. A frequent contemporary dilemma is found in the vii viii Foreword 2 decision- making process as to whether to regenerate lost periodontium or to replace a compro- mised tooth with a dental implant. This everyday decision may result in a collision of thera- pies. Adequate presurgical planning, appropriate quality and quantity of available bone, and excellent surgical technique will all play a vital role in a successful outcome. Leandro Chambrone has captured the moment with a detailed analysis of therapies for the periodontally compromised patient. This is an excellent, well-documented textbook that should be found in the library of every dental practitioner. Swampscott, USA Myron Nevins Pref ace It is somewhat interesting what ways life takes and how things happen in our lives. I had never even the idea of writing a scientifi c book or even the purpose of presenting it in a different concept than peridontology textbooks have ever done. However, the fi rst contact invitation performed by Springer Verlag for a new book on P eriodontal Plastic Surgery led me to develop a bunch of new ideas on how to present additional information to what several very good books on the same topic had already published. After thinking for a while, the best option seemed to explore all the knowledge obtained during the 8 years I have been studying working on “evidence-b ased dentistry,” with all the clinical work developed during 15 years of private practice. Thus, the development of a book entitled Evidence-Based Periodontal and Peri- Implant Plastic Surgery emerged to support the rational and clinical use of different surgical procedures in “real-world clinical scenarios” or, in other words, to really sediment the original concept of evidence-based dentistry and provide a rational and viable sequence of combined events: (1) the assessment of the best source of information available for each specifi c clinical condition or disease; (2) the proposal of an order of “best to worst” treatment options that may be offered to solve the “problem” of the patient taking into account the clinician’s expertise; and (3) the patient’s choice after considering the clinical options and one’s personal preferences. It is expected that the proposal of any particular concept should rely on a vision of how to share its content within a large audience, but in fact, my idea (and certainly, I can talk on behalf of all colleagues participating in this project) is that this book could be useful for clini- cians attending in conventional private practices: nothing more, nothing less than that. Together with some young and talented Latin American clinicians and Prof. Dr. Luiz Armando Chambrone (who “presented” us with his know-how of 50 years of clinical expertise), I am very glad to offer the readers a way to go further on existing knowledge to determine the best ix