To avoid nerve injury during surgery in the foraminal area, guidelines were developed based on the literature with respect to verifying the position of the mental foramen and validating the presence of an anterior loop of the mental nerve. These guidelines included leaving a 2 mm zone of safety between an implant and the coronal aspect of the nerve; observation of the inferior alveolar nerve and mental foramen on panoramic and periapical films prior to implant placement; use of CT scans when these techniques do not provide clarity with respect to the position of the nerve; surgical corroboration of the mental foramen's position when an anterior loop of the mental foramen is suspected of being present or if it is unclear how much bone is present coronal to the foramen to establish a zone of safety (in millimeters) for implant placement; once a safety zone is identified, implants can be placed anterior to, posterior to, or above the mental foramen; and prior to placing an implant anterior to the mental foramen that is deeper than the safety zone, the foramen must be probed to exclude the possibility that an anterior loop is present. In general, altered lip sensations are preventable if the mental foramen is located and this knowledge is employed when performing surgical procedures in the foraminal area.

This review article evaluates the role of local drug delivery systems in the management of periodontal diseases. The efficacy of several local delivery devices (i.e., tetracycline fibers, metronidazole and minocycline gels, chlorhexidine chips, and doxycycline polymer) which are either commercially available in the United States or abroad, or are currently under consideration for Food and Drug Administration (FDA) approval are discussed. The drug delivery systems are assessed with regard to their functional characteristics, effectiveness as a monotherapy, as compared to scaling and root planing, and ability to enhance conventional therapy. Furthermore, controversies associated with local delivery are addressed (e.g., induction of bacterial resistant strains, the efficacy of systemic versus local drug delivery, and whether local drug delivery should function as an alternative or as an adjunct to conventional treatment).

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The purpose of this chapter is to set the stage for the more detailed information to follow in the succeeding sections of this work. The reader will be familiarized with the terms and definitions commonly used in periodontal wound healing and the methods used to evaluate the results of periodontal therapy. A discussion of the effects of conventional periodontal therapy will then be followed by a review of biological factors that must be considered if periodontal therapy is to result in regeneration.

Proposing to place endosseous implants is an integral facet of dental treatment plans. Their insertion is usually associated with a low incidence of untoward events. However, despite careful planning, surgical complications can arise: infection, intraoral hemorrhage, wound dehiscence, postoperative pain, lack of primary implant stability, inadvertent penetration into the maxillary sinus or nasal fossa, sinus lift sequelae, neurosensory disturbances, injuries to adjacent teeth, tissue emphysema, and aspiration, or ingestion of surgical instruments. This article addresses some surgical complications associated with dental implant placement and discusses how to avoid and manage them when they occur.

Chlorhexidine is an effective antimicrobial agent. Its application can enhance periodontal therapy. The pharmacology of chlorhexidine and suggestions for its use are outlined. In addition, its potential for inducing cancer and bacterial resistance are discussed.

This literature review is concerned with the ability of personal oral hygiene and mechanical instrumentation to establish and maintain periodontal health. Clinical, microbiologic, and histologic responses to non-surgical therapy are evaluated to provide guidelines for expected treatment results. Factors that may limit the effectiveness of non-surgical therapy as a closed procedure are also addressed. These include length of therapy, skill of therapists, patient compliance, responsibility of clinician for maintenance, and disease activity status of the patient.

Assessment of bleeding upon probing is an integral part of a periodontal examination. Recent investigations have indicated that bleeding reflects histological, clinical and bacteriological alterations associated with periodontal disease. Furthermore, clinical and histologic data suggest that bleeding is an earlier sign of gingivitis than visual signs of inflammation (redness and swelling). The current literature referring to the role of bleeding upon probing in the diagnosis of periodontal disease is reviewed, and its limitations as a clinical parameter are discussed.