Diseases and Conditions in Dentistry

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