European Journal of Prosthodontics and Restorative Dentistry
Book Reviews
Abstract
Practical Advanced Periodontal Surgery. Serge Dibart. ISBN: 978 0 8138 0957 1 Wiley Blackwell. Hardback. 192 pages. £39.50
This book is written by one of the recognised leaders in the field of periodontal surgery, Serge Dibart and a team of experts, mostly drawn from the faculty of Boston University Goldman School of Dental Medicine, many of whom have had a significant input in developing novel periodontal surgical techniques. The book is extremely well illustrated with a large number of very high quality images of the pre-, peri- and post-operative appearance of patients undergoing a number of complex periodontal surgical procedures. The book is organised into 11 chapters, which cover aspects of bone physiology and metabolism, wound healing and aspects of complex and advanced periodontal surgery. The chapters are written by different people which, on one hand, occasionally results in some variations in terminology, but on the plus side results in an interesting array of different writing styles and case presentations. The book clearly was written by colleagues trained in America. Thus, readers in the UK and Europe may not rejoice in some of the terminology such as terms like “cuspid” and “laid a flap”. The book provides a very comprehensive resume of current knowledge on bone biology together with an extensive consideration of wound healing. The surgical anatomy relevant to the periodontium is described in great detail which is welcomed as this area is often overlooked. The bulk of the book presents various cases involving combined orthodontic, restorative, endodontic and prosthodontic approaches together with periodontal surgical techniques. Some of the procedures are very extensive and are not routinely undertaken in UK or Europe. An example is periodontally accelerated osteogenic orthodontics (PAOO); this is a technique in which a full thickness flap is raised and then holes/grooves are drilled into the cortical bone to encourage bleeding. The surgical area is then covered with a bone graft and the flap is replaced. The aim is to increase the alveolar bone volume and reduce the chance of relapse following orthodontic treatment, but this is a very invasive surgical technique and there are no mentions of the possible negative consequences of this procedure or its limitations. The same chapter also includes the interesting topic of placement of mini-screws directly into the bone with the screw heads exposed in the oral cavity as a means of providing orthodontic retention as the screws are effectively immobile and don’t move (unlike teeth) when used for anchorage. Chapter 5, which covers surgical endodontics is a pleasure to read. It is very pragmatic and argues that not all teeth with endodontic involvement should be extracted and implants placed. The chapter is philosophical and considers the different ways of defining success when considering the outcomes of root canal therapy versus implant placement and advocates that the reader avoids “herodontics”. The chapter also has a very interesting section on intentional re-implantation of endodontically-treated teeth following extraction and root preparation. As would be expected, the use of MTA is extensively covered. The chapter on periodontal and prosthodontic surgery describes very complex cases that include various combinations of crown lengthening, grafting, implant placement, crown and bridge-work, all of which are beautifully photographed and annotated and all which have spectacular outcomes. There is also a chapter on alveolar distraction surgery as a means of increasing alveolar bone volume. Concepts of papilla preservation are emphasised throughout the book, which also includes a summary on the placement of short implants. Techniques for sinus augmentation are presented. A case is described involving a missing maxillary first molar with inadequate bone volume for placement of implants. The patient undergoes an extensive procedure including sinus lifting, bone grafting and implant placement. Many practitioners would question whether this is the best option for the patient who could have easily and effectively been managed by the placement of an adhesive cantilever bridge. A section at the end of the book on periodontal medicine feels slightly out of place. This chapter describes various oral pathology and oral medicine findings such as pyogenic granulomas, mucoceles, lichen planus, pemphigoid, etc and brief descriptions of these conditions are presented together with brief summaries of treatment options. Overall, this book is beautifully illustrated with high quality images, showing a variety of extensive and advanced periodontal surgical techniques. It is not likely to be of much use to the general dentist, and only a small proportion of periodontists will be regularly undertaking the types of procedures described in the book. However, for those clinicians who are interested in furthering their surgical knowledge, this book may be useful though of course could not, in any way, substitute for adequate training under close supervision. Criticisms relate to the fact that the majority of cases presented involve very complex, expensive and lengthy surgical interventions. There is no real discussion of alternative options that might be considered, and in many cases there may be much simpler and more conservative treatment options which would be perfectly adequate. There is also no critical appraisal of the techniques which are presented and no evidence base regarding the success rates and outcomes of the pro-
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