Table Of ContentPPaaggee__FFMM..iinndddd ii 2277//1122//1100 44::5566 PPMM
Klaus H. Rateitschak
in memoriam
PPaaggee__FFMM..iinndddd iiii 2277//1122//1100 44::5566 PPMM
Color Atlas of Dental Medicine
Editors: Klaus H.Rateitschak and Herbert F.Wolf
Periodontology
Herbert F.Wolf
Edith M. & Klaus H. Rateitschak
Thomas M. Hassell
Forewords by Samuel B. Low and Maurizio S.Tonetti
3rdrevised and expanded edition
1870 illustrations
Thieme
Stuttgart · NewYork
PPaaggee__FFMM..iinndddd iiiiii 2277//1122//1100 44::5566 PPMM
IV
Series Editors: Dr. Herbert F. Wolf Dr. Edith M. Rateitschak-Plüss
Private Practicioner—Periodontics SSO/SSP OA emeritus, Dept of Cariology and
Klaus H. Rateitschak † Löwenstrasse 55/57, 8001 Zurich Periodontology, Dental Institute
Herbert F. Wolf Switzerland University of Basle
Email: [email protected] Glaserbergstrasse 19, CH-4056 Basle
Email: [email protected]
Authors—Periodontology: Dr. Thomas M. Hassell Dr. Klaus H. Rateitschak †
Professor, D.D.S., Dr.med.dent., Ph.D. Formerly Professor and Chairman
Herbert F. Wolf Northern Arizona University Department of Cariology and
Edith M. & Klaus H. Rateitschak Flagstaff, Arizona, USA Periodontology, Dental Institute
Thomas M. Hassell Email: [email protected] University of Basle, Switzerland
Library of Congress Cataloging-in- Important note: Medicine is an ever-
Publication Data In the Series “Color Atlas of Dental Medicine” changing science undergoing continual
development. Research and clinical expe-
Periodontology, English rience are continually expanding our
Color Atlas of Dental Medicine / R. Beer, M.A. Baumann, S. Kim knowledge, in particular our knowledge
editors, Klaus H. Rateitschak and ● Endodontology of proper treatment and drug therapy. In-
Herbert F. Wolf; forewords by Roy sofar as this book mentions any dosage or
C. Page and Hubert E. Schroeder.— application, readers may rest assured that
A.Bumann, U. Lotzmann, J. Mah
2nd ed. Adaption of: Parodontologie, the authors, editors, and publishers have
2nd, 1989. ● TMJ Disorders and Orofacial Pain made every effort to ensure that such ref-
Rev. ed. of: Color Atlas of Periodontology / erences are in accordance with the state
Klaus H. Rateitschak… [et al.] 1985. A.H. Geering, M. Kundert, C.C. Kelsey of knowledge at the time of production
Bibliography: p. Includes Index. ● Complete Denture and Overdenture Prosthetics of the book.
Contents: v.l. Periodontolgy / Nevertheless, this does not involve, imply,
Klaus H. Rateitschak… [et al.] or express any guarantee or responsibility
G. Graber
1. Dentistry—Atlases. on the part of the publishers in respect to
I. Rateitschak, Klaus H. II. Color ● Removable Partial Dentures any dosage instructions and forms of ap-
Atlas of Periodontology, III. Title. plications stated in the book. Every user
[DNLM; 1. Periodontics—Atlases. F.A. Pasler is requested to examine carefully the
WU 17 P257c] manufacturers’ leaflets accompanying
● Radiology
RK287.P3713 1989 each drug and to check, if necessary in
617.6’320754-dc20 consultation with a physician or specialist,
DNLM/DLC Th. Rakosi, I. Jonas whether the dosage schedules mentioned
for Library of Congress ● Orthodontic Diagnosis therein or the contraindications stated by
the manufacturers differ from the state-
ments made in the present book. Such ex-
P.A. Reichart, H.P. Philipsen
amination is particularly important with
● Oral Pathology drugs that are either rarely used or have
been newly released on the market. Every
H. Sailer, G.F. Pajarola dosage schedule or every form of applica-
● Oral Surgery for the General Dentist tion used is entirely at the user’s own risk
and responsibility. The authors and pub-
1stGerman edition 1984 J. Schmidseder lishers request every user to report to the
1stEnglish edition 1985 publishers any discrepancies or inaccura-
1stFrench edition 1986 ● Aesthetic Dentistry cies noticed. If errors in this work are
1stSpanish edition 1987 found after publication, errata will be
1stJapanese edition 1987 H. Spiekermann, K. Donath, T. Hassell, S. Jovanovic, posted at www.thieme.com on the prod-
1stItalian edition 1988 J. Richter uct description page.
2ndGerman edition 1989 ● Implantology
2ndEnglish edition 1989 Some of the product names, patents, and
2ndSpanish edition 1991 H.F. Wolf, E.M. & K.H. Rateitschak, T.M. Hassell registered designs referred to in this book
2ndFrench edition 1991 are in fact registered trademarks or pro-
● Periodontology
prietary names even though specific refer-
3rdGerman edition 2004 3rdedition ence to this fact is not always made in the
text. Therefore, the appearance of a name
© 1985, 2005 Georg Thieme Verlag, without designation as proprietary is not
Rüdigerstraße 14, 70469 Stuttgart, to be construed as a representation by the
Germany publisher that it is in the public domain.
http://www.thieme.de
Thieme New York, 333 Seventh Avenue, This book, including all parts thereof, is le-
New York, NY 10001 USA gally protected by copyright. Any use, ex-
http://www.thieme.com ploitation, or commercialization outside
the narrow limits set by copyright legisla-
Typesetting by primustype Hurler GmbH, tion, without the publisher’s consent, is il-
Notzingen legal and liable to prosecution. This ap-
Printed by K. Grammlich, Pliezhausen plies in particular to photostat reproduc-
tion, copying, mimeographing, prepara-
ISBN 3-13-675003-9 (GTV) tion of microfilms, and electronic data
ISBN 0-86577-902-3 (TNY) 1 2 3 4 5 processing and storage.
PPaaggee__FFMM..iinndddd iivv 2277//1122//1100 44::5566 PPMM
V
Preface to the Third Edition
This Third Edition of the Color Atlas of Periodontology now Because of this fact, the following chapters or sections have
emerges, more than 13 years after the Second. The reasons been rearranged, expanded, sometimes shortened, or in
for the long delay are many, but the saddest was the passing many cases completely rewritten:
of our colleague and friend, and co-author Edith’s husband, • An introduction for the “layperson,” the patient
Klaus Rateitschak, on September 30, 2002. We dedicate this • Etiology—Dental plaque as a “biofilm”; the periodonto-
Third Edition to him, an edition on which he worked inten- pathic microorganisms
sively, up to the very end, and in which he found immense • Pathogenesis—Host response, risk factors
joy and satisfaction in the almost innumerable innovations • Oral pathological changes in gingiva and periodontium
that the 1990s brought to our profession, while launching it • Oral manifestations of HIV-disease. Treatment possibili-
into the 21st Century. ties
• Gingival recession—“Prevention before surgical treat-
The turn of the century presented to us the opportunity to ment”
freshly analyze what had been achieved, and to define new • The “systemic pre-phase” of periodontal therapy
goals for the future. Dentistry and especially periodontology • Non-surgical, “closed” periodontal therapy—Promising
received fresh and fervent impetus to integrate new and rel- new techniques
evant scientific and clinical knowledge into our daily profes- • Pharmacologic strategies for the treatment of periodonti-
sional practices, including even total paradigm shifts. These tis
facts in themselves presented sufficient basis for us to total- • Surgery—Principles of access flaps for “open” root de-
ly revise the Second Edition, maintaining of course those bridement
concepts and treatment modalities that have stood the test • Regenerative and resective surgical methods
of time, but incorporating exciting new findings that have • Furcation involvement—Classifications and treatment
immediate clinical applicability. options
The most noble task of a dentist—also the watchword of our • Esthetic surgery—Mucoplastic operations
now departed colleague—is to maintain the health and • Risk-managed maintenance therapy—Success and failure
well-being of the patient. This translates in our profession • Periodontics and prosthetics—Standard and esthetic
into the prevention of oral diseases. possibilities
• Ridge augmentation using soft tissue
However, if, despite our best efforts in prevention, damage • Indication for implants in the periodontally treated
to tooth structure and the periodontium occur, treatment of dentition
the periodontal condition must be the fundamental endeav- • Periodontal tissues in the elderly
or, even before any further dental therapy. Each and every • Comprehensive classification of periodontal diseases—
restorative effort—from the smallest filling through remova- Original 1999 text, AAP/EFP
ble partial dentures and to complex fixed bridge construc-
As always before, every effort was made in this Third Edi-
tions, regardless of whether these are tooth-borne or im-
tion to fully integrate the text and the illustrations, to make
plant-borne—must be undertaken only when the supportive
it pleasant (or at least easier) for the reader as she/he stud-
periodontal tissues are inflammation-free and healthy.
ies or simply peruses the book. Nevertheless, the compre-
Inflammatory periodontal diseases today represent some of
hensive nature and thus the very weight of this new trea-
the most widespread health problems in the world. The ef-
tise, this Third Edition, have essentially removed it from the
fects of periodontal diseases upon systemic health are
ranks of a bedside reader. For this we apologize!
becoming clearer almost daily. To ignore these now obvious
associations is quickly becoming unacceptable.
Herbert F. Wolf, Zürich
Edith M. Rateitschak-Plüss, Basle
Thomas M. Hassell, Flagstaff
PPaaggee__FFMM..iinndddd vv 2277//1122//1100 44::5566 PPMM
VI
Foreword to the Third Edition—I
Samuel B. Low, D.D.S., M.Ed.
Professor of Periodontology
College of Dentistry, University of Florida
Diagnosis and treatment of the diseases of the periodonti- scope of periodontology has as its domain allof the oral cav-
um remain as one of the critical components of the practice ity, and especially as it relates to the patient’s systemic
of dentistry. However, implementation of periodontal thera- health.
py as a component of comprehensive oral care remains to-
day a significant challenge. One major aspect of understand- However, the most comprehensive section is that of therapy,
ing contemporary concepts of periodontology is locating an where all phases of surgical and non-surgical treatment are
appropriate resource that contains the time-proven funda- covered in all facets. While most authors would abhor the
mentals of therapy while providing the recipient with cut- similarities of a “cook book,” the practitioners who desire to
ting edge, new information. The dental practitioner com- expand their repertoire will be delighted with the attention
munity continues to seek clarity in a discipline that moves to detail. And while the accepted concept is that textbooks
into the 21st Century with lightening speed. Moreover, to- are already “history,” the therapy sections defy this concept,
day’s clinician—whether it be the dental student or the sea- including areas involving mucogingival procedures that are
soned dentist—desires information in a format that is time- very current, even progressive. Few texts can compare with
effective, not verbose, and visually appealing. This Third the quality of illustrations superimposed upon the truly ex-
Edition of the Color Atlas of Periodontology bears a title that cellent intraoral photography. One also notes that all proce-
could be considered by some to be a misnomer, for it is far dures are presented with objectivity and with no predilec-
from merely a collection of illustrations, diagrams, and clin- tion to any particular philosophy. References to products are
ical photographs. There exists also a more than adequate handled in a manner that allows the clinician to make un-
text, whereby passages and illustrations blend together in a biased choices.
synergistic fashion and with harmony.
Today’s clinician must be knowledgeable in esthetic den-
In recent decades, periodontology has benefited from a tistry. The reader will find a seamless integration of peri-
mainstay of infusion of clinical and laboratory science into a odontal concepts with the discipline of prosthodontics. Well
discipline whose goal is retaining the dentition. This Third documented cases provide a clear understanding of what
Edition contains very comprehensive sections in the area of can be achieved in the perio/restorative esthetic environ-
microbiology, and more importantly host defense mecha- ment. For the restorative dentist, step-by-step procedures
nisms in the subject of pathogenesis. When one peruses are presented in the areas of basic biologic width, enhance-
these respective chapters, it becomes evident that the text is ment of interdental papillae, and dealing with alveolar ridge
illustrated in such a clear manner that what can be difficult defects.
in comprehension can be readily grasped in understanding.
Terminology and definitions are current and in alignment In summary, few practitioners will find a more all-inclusive
with today’s published concepts. Serious attention is given text on periodontology that will appeal to all levels of clini-
to data collection and diagnosis. There are accurate descrip- cians, dental students, and periodontics graduate students.
tions of current diagnostic tests, whether they are from a The format is very user-friendly, with intent to provide the
microbiologic venue or in a host response category. What is reader with a comprehensive reference in a time-effective
particularly gratifying is a strong section in oral pathological manner. I suggest this Third Edition as required reading for
alterations of the periodontium. The current and future all who are engaged in rendering periodontal therapy.
PPaaggee__FFMM..iinndddd vvii 2277//1122//1100 44::5566 PPMM
VII
Foreword to the Third Edition—II
Maurizio S. Tonetti, D.M.D., Ph.D., M.M.Sc., F.D.S., R.C.P.S.
Professor of Periodontology
Eastman Dental Institute, University College London
The Color Atlas of Periodontology, first published in 1984, has this book particularly attractive: As progress in the science
come to its third, thoroughly revised and extensively ex- of periodontology steamed along, the gap between this and
panded edition, being a cherished classic in the library of the reality of practice has grown ever wider. The Atlasoffers
practitioners, students, and teachers of this discipline. students and clinicians the opportunity to reflect on the
Having used the First Edition as one of the reference text- profound changes that have occurred and illustrates concise
books during my specialist training, and having “borrowed” and practical approaches to use the new and emerging
many diagrams from the Second Edition to illustrate diffi- knowledge for the benefit of periodontal patients today.
cult concepts to my students, it is with particular pleasure
that I write this Foreword to the new edition of the Color At- Periodontology has reached a critical turning point: A better
las of Periodontology. understanding of the etiology and pathogenesis of the
different forms of periodontitis and the recognition of the
This new edition represents both an element of evolution critical role played by individual susceptibility traits have
and of revolution with respect to the previous ones. Evolu- laid the foundations for new, more effective treatment
tion since the authors have expanded and brought to per- strategies. Better diagnosis and risk assessment, new treat-
fection what has rendered the Atlasa true classic: The clari- ment alternatives, an unprecedented body of scientific evi-
ty of a synthetic up-to-date discussion of the critical topics dence in support of what we should do (and perhaps more
in periodontology based on text, diagrams, and generous, importantly what we should no longer do) will be useless if
detailed illustration. It is the ideal media to capture both they do not find their way into daily clinical practice.
theoretical and clinical concepts in an effective, time-effi-
cient manner. The Atlas continues to be a didactic master- It is therefore my wish that the readers of this work will be
piece making both scientific discovery and clinical progress open to the changes in their daily practice that current re-
accessible. search in periodontology has to offer.
The Atlas is also an element of revolution since the authors My thanks go the Wolf/Rateitschak/Hassell team for an-
have tried to implicate in clinical practice the paradigm other masterful contribution.
changes that have originated from the last 20 years of fun-
damental and clinical research. It is this attempt that makes Bravo and Encore!
PPaaggee__FFMM..iinndddd vviiii 2277//1122//1100 44::5566 PPMM
VIII
Acknowledgments
First and foremost, we thank our families and our friends for All of the graphic illustrations, schematic diagrams, and ta-
their unflagging encouragement and support, and for their bles conceived by Herbert Wolf were realized on the compu-
deep understanding and even deeper patience over more ter with great competence (and understanding for the aut-
than a decade of work as this Third Edition evolved and be- hors’ unending litany of desires) by Joachim Hormann,
came a reality. I, Herbert Wolf, personally take this opportu- Graphic Design Co., Stuttgart. He deserves our special thanks.
nity to thank Klaus “Pascha” Rateitschak who, years before Also soworthy of our thanks and praise are Ms. Censeri Abare
his death, honored me with the knowledge that I would be (Gainesville, FL) and Ms. Heidi Hamberger(Basle), who pre-
first author on this completely revised Third Edition of our pared the original typescript for this book and then also per-
Atlas. Pascha and I became friends and collaborators in the formed countless corrections and modifications of innumer-
early 1960s, when we started our careers under the men- able drafts, always with precision and with patience.
torship of Dr. Hans R. Mühlemann, scientist and teacher at
the University of Zurich. Since the initiation of the First Edition of this Atlas (1978),
Dr. Christa Durach and photographer Dieter Isch have stood
The creation of this book, which became ever more compre- by our side faithfully and with critically important contribu-
hensive and detailed, was made possible only through the tions. Our deepest thanks go to these two outstanding indi-
collaboration and assistance of the coworkers in Dr. Wolf’s viduals.
private dental practice (Zurich, Switzerland), our colleagues
in the Center for Dental Medicine (Basle, Switzerland), and The enormous costs for all of the color illustrations were
the faculty, staff, and students at the College of Health Pro- born by the authors and by our publisher, and the following
fessions, Northern Arizona University (Flagstaff, AZ). In our commercial entities made significant financial contribu-
work, we were helped greatly by contributions from other tions:
universities and many private dental and periodontal prac-
tices. Contributions of clinical cases and photographs are Procter & Gamble Co., Trisa Co., Deppeler Co., Gaba Co., Lever
acknowledged in detail on page 524. Co., and theWalter-Fuchs Foundation.
We also thank especially Dr. Samuel Low(Gainesville, Flori-
da) and Dr. Maurizio Tonetti (London, England) for their Our text and illustrative materials were prepared for final
generous, original, and objective new forewords to this printing in the Kaltnermedia Co. in Bobingen, by Martin
Third Edition. Maschke, Markus Christ,and Angelika Schönwälder, who per-
formed brilliantly with understanding, know-how, and en-
Our thanks go to our many colleagues worldwide for their during patience. Despite the ever-present time pressure,
participation as contributors, assistants, photographers, GrammlichCo., Pliezhausen,carried out the work with preci-
therapists, problem-solvers, and “critics”: Andreas Adler, sion and persistence.
Basle—Sandra and Christian Augustin-Wolf, Zurich—Christine
Baca, Flagstaff—Manuel Battegay, Basle—Jean-Pierre Ebner, Once again, in this Third Edition, we have been immensely
Basle—Daniel Edelhoff, Aachen—Joachim Hermann, Zurich— grateful for the excellent guidance and support provided to
Markus Hürzeler, Munich—Marco Imoberdorf, Zurich— us by Thieme Medical Publishers, Stuttgart and New York.
Thomas Lambrecht, Basle—Niklaus Lang, Berne—Samuel Low, Special thanks are due to Dr. Christian Urbanowicz, Markus
Gainesville—Pascal Magne, Geneva—Michael Marxer, Pohlmann, Karl-Heinz Fleischmann and his successor Rolf
Lucerne—Carlo Marinello, Basle—Martin Meyer, Zurich—Jürg Zeller. These individuals put every ounce of energy, dedica-
Meyer, Basle—Andrea Mombelli, Geneva—Rainer Oberholzer, tion, and personal creativity into this book, and always exhi-
Suhr—Lucca Ritz, Basle —Hubert Schroeder, Zurich—Ulrich bited understanding (and patience!) for the authors’
Saxer, Zurich—Peter Schüpbach, Horgen—Stephan Studer, numerous and often “impossible” wishes.
Zurich—Maurizio Tonetti, London—Anton Wetzel, St. Gallen—
Lennart Wieslander, Basle—Jakob Wirz, Winterthur—Nicola Herbert F. Wolf
Zitzmann, Basle. Edith M. Rateitschak-Plüss
Thomas M. Hassell
PPaaggee__FFMM..iinndddd vviiiiii 2277//1122//1100 44::5566 PPMM
IX
Table of Contents
79 Gingivitis
Fundamentals 80 Histopathology
81 Clinical Symptoms
1 Introduction 82 Mild Gingivitis
1 Periodontal Diseases 83 Moderate Gingivitis
4 The Clinical Course of Untreated Periodontitis 84 Severe Gingivitis
4 Periodontitis—Concepts of Therapy
85 Ulcerative Gingivitis/Periodontitis
7 Structural Biology 86 Histopathology
8 Gingiva 87 Clinical Symptoms—Bacteriology
10 Epithelial Attachment 88 Ulcerative Gingivitis (NUG)
12 Connective Tissue Attachment 89 Ulcerative Periodontitis (NUP)
14 Root Cementum 90 Ulcerative Gingivoperiodontitis—Therapy
16 Osseous Support Apparatus
18 Blood Supply of the Periodontium 91 Hormonally Modulated Gingivitis
19 Innervation of the Periodontium 93 Severe Pregnancy Gingivitis—Gravid Epulis
20 The Coordinated Functions of the Periodontal Structures 94 Pregnancy Gingivitis and Phenytoin
21 Etiology and Pathogenesis 95 Periodontitis
22 Periodontitis—A Multifactorial Disease 96 Pathobiology—The Most Important Forms of Periodontitis
96 Type II
23 Microbiology 96 Type III B
24 Biofilm—Plaque Formation on Tooth and Root Surfaces 97 Type III A
25 Supragingival Plague 97 Type IV B
26 Natural Factors Favoring Plaque Retention 98 Pathomorphology—Clinical Degree of Severity
27 Iatrogenic Factors Favoring Plaque Retention 99 Pockets and Loss of Attachment
28 Subgingival Plaque 100 Intra-alveolar Defects, Infrabony Pockets
29 Bacterial Invasion Into Tissue? 102 Furcation Involvement
30 Classification of Oral Microorganisms 104 Histopathology
31 Cell Walls of Gram-Positive and Gram-Negative Bacteria 105 Additional Clinical and Radiographic Symptoms
32 Periodontitis—Classical or Opportunistic Infection? 108 Chronic Periodontitis—Mild to Moderate
33 Putative Periodontopathic Bacteria 110 Chronic Periodontitis—Severe
34 Virulence Factors 112 Aggressive Periodontitis—Ethnic Contributions?
34 Virulence Transfer 114 Aggressive Periodontitis—Acute Phase
36 Marker Bacteria in Periodontitis 116 Aggressive Periodontitis—Initial Stage
37 Pathogenic “Single Fighters” vs. Pathogenic Complexes? 118 Prepubertal Periodontitis—PP (Aggressive Periodontitis)
38 Endotoxins—Lipopolysaccharide (LPS)
38 Interaction Between LPS and the Host 119 Oral Pathologic Alterations
of Gingiva and Periodontium*
39 Pathogenesis—Reactions and Defense Capabilities of the Host 120 Primarily Gingival Alterations (Type I B)
40 New Concepts of Pathogenesis 120 Gingival and Periodontal Alterations (Type IV A/B)
–Therapeutic and Diagnostic Consequences 121 Phenytoin-Induced Gingival Overgrowth
41 Host Response—Mechanisms and “Participants” 122 Dihydropyridine-induced Gingival Overgrowth
42 Non-specific, Congenital Immunity—the First Line of Defense 123 Cyclosporine-induced Gingival Overgrowth
43 Specific, Acquired Immunity—the Second Line of Defense 124 Gingival Hyperplasia Following Combined Drug Therapies
44 Components of the Immune System—Summary 125 Benign Tumors—Epulis
45 Interactions Between Non-specific and Specific Immunity 126 Benign Tumors—Fibrosis, Exostosis
46 Regulatory Cell Surface Molecules: Markers, Receptors 127 Malignant Tumors
47 Cytokines 128 Gingivosis/Pemphigoid
49 Eicosanoids—Prostaglandins and Leukotrienes 128 Pemphigus vulgaris
50 Enzymatic Mechanisms—Matrix Metalloproteinases 129 Lichen planus: Reticular and Erosive
51 Risk for Periodontitis—the Susceptible Host 130 Leukoplakia, Pre-Cancerous Lesions—Oral Granulomatoses
52 Genetic Risk Factors—Diseases, Defects, Variations 131 Herpes—Herpetic Gingivostomatitis
54 Alterable Risk Factors, Modifying Co-Factors 132 Periodontitis with Systemic Diseases (Type IV)—Diabetes Type I and Type II
55 Pathogenesis I—Initial Inflammatory Reactions 134 Periodontitis Associated with Systemic Diseases (Type IV B)
56 Pathogenesis II—Histology Down Syndrome, Trisomy 21, “Mongolism”
58 Pathogenesis III—Molecular Biology 136 Pre-pubertal Periodontitis Associated with Systemic Disease
60 Attachment Loss I—Destruction of Connective Tissue Papillon-Lefèvre Syndrome (Type IV B)
61 Attachment Loss II—Bone Resorption 138 Papillon-Lefèvre Syndrome—“An Exception for Every Rule”
62 Pathogenesis—Clinical Features: From Gingivitis to Periodontitis
63 Cyclic Course of Periodontitis 139 HIV Infection—AIDS
64 Periodontal Infections and Systemic Diseases 140 HIV Disease—Epidemiology
65 Etiology and Pathogenesis—Summary 141 Classification and Clinical Course of HIV Disease
142 Oral Manifestations of HIV Disease
67 Indices 143 Bacterial Infections in HIV
70 Papilla Bleeding Index—PBI 144 Fungal Infections
71 Periodontal Indices 145 Viral Infections
72 Community Periodontal Index of Treatment Needs—CPITN 146 Neoplasms
73 Periodontal Screening and Recording—PSR 147 HIV-Associated Lesions of Unknown Etiology
148 Invasion and Replication of the HI Virus—
74 Epidemiology Hurdles for Systemic Medical Treatment
74 Epidemiology of Gingivitis 149 Treatment of the HIV Patient—Pharmacologic Aspects
75 Epidemiology of Periodontitis 150 HIV—Treatment of Opportunistic Infections
76 WHO Studies 150 Infection Prevention and Post-exposure Prevention—The Dental Team
151 Treatment of HIV-Periodontitis
Disease Entities and Diagnosis 155 Gingival Recession
156 Fenestration and Dehiscence of the Alveolar Bone
77 Types of Plaque-associated Periodontal Diseases 157 Clinical Symptoms
77 Gingivitis—Periodontitis 158 Recession—Localized
78 Classification of Periodontal Diseases—Nomenclature 159 Recession—Generalized
PPaaggee__FFMM..iinndddd iixx 2277//1122//1100 44::5566 PPMM
