14a periodontal inter-relationship

7/30/2019 14a Periodontal Inter-relationship

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PERIODONTAL : RESTORATIVEINTER-RELATIONSHIP

Department of

Periodontics


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INTRODUCTION

It is well established fact that the

periodontal health and the restoration

of teeth share an intimate and

inseparable interrelationship


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For restorations to survive, long term

restorative procedures must be performedon a

Periodontium free of inflammation

Pockets without any mucogngival involvement

With the contour and shape of the

Periodontium corrected for a good functional

and esthetic restorative result.


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CONTROLOF ACTIVE DISEASE

Emergency treatment

Extraction of hopeless teeth

Oral hygiene instructionsScaling and root planing

Re-evaluation

Periodontal SurgeryAdjunctive Orthodontic therapy


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MARGINS OF THE RESTORATIONS

A clinician has three options for margin

placement:

Supragingival

Equigingival (even with the tissue)

Subgingival

Contd.


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3. The greatest biologic risk occurs when

margins are placed subgingivally

4. Both supragingival and equigingival

margins are well-tolerated.

Contd.


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5. In view of the scientific evidence

available, restorative margins should bepreferably placed supragingivally.

However in certain situations, where

subgingival margins are unavoidable likecarious tooth, tooth fracture of aesthetic

concern, it should be placed not more

than 0.5 mm into the sulcus so that, thesemargins could be assessable for finishing

procedure


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If the margins are placed to far belowthe gingival tissue crest, it violates the

gingival attachment apparatus.


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RESTORATIVE MARGIN ENCROACHING ON THE

BIOLOGIC WIDTH

The soft tissue attachment to the toothbetween the base of the gingival sulcus

and the crest of the alveolar bone is called

the biologic width.Invasion into this biologic width should be

avoided in order to prevent attachment loss

and persistent gingival inflammation.

Biologic width = Junctional epithelium(0.97

mm) + connective tissue attachment (1.07

mm) = 2.04 mm


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CROWN CONTOUR

Restoration contour plays an

important role in the maintenance of

periodontal health. An ideal contour

must provide:

1. Access for hygiene

2. Fullness to create the desired gingival

form

3. Esthetically pleasing tooth contour.


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4. Protection of the marginal gingiva frommechanical injury during mastication.

The crown contour should, help in easy

plaque removal, not its retention,overcontouring leads to more plaque

accumulation with subsequent gingival

inflammation, under contouring of crownsis therefore considered ideal.


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HYPERSENSITIVITY TO DENTAL

MATERIALS

From periodontal point of view glass

ionomer seems to be more acceptablethan composite because of its

capability to release fluoride that has

the potential to interfere with

adherence of bacteria on the tooth

surface.


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PROXIMAL CONTACT AND

EMBRASURE

The ideal interproximal embrasure should

house the gingival papilla without

impinging on it. Proper proximal contact is

essential to prevent food impaction. Thecontact point should be placed occlusally

and facially to facilitate access for

interproximal plaque control. The idealcontact should be 2 to 3 mm coronal to the

attachment.


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PONTIC DESIGN

Traditionally, for types of pontic designs have

been proposedSanitary, ridge lap, modifiedridge lap and oviate pontic designs.

1. Sani tary pont ic:Where the tissue surface of

the pontic is 3 mm from the underlying ridge.


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2. Ridge lap pon t ic:Where the tissue

surface of the pontic is much like a

saddle. The entire surface is convex andis very difficult to clean.


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3. Modified ridge lap pontic: The tissue

surface on the facial surface is concave,

however, the lingual saddle is removedto allow access for oral hygiene.


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4. The oviate pontic: This is the ideal

pontic design. It is created by forming a

receptor site in the edentulous ridge witheither a diamond bur or electrosurgery.


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Whenever fixed prosthesis is designed

to replace missing teeth, contact

between the pontic and mucosashould be avoided or kept minimal so

that meticulous plaque control can be

advocated.


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CONCLUSION

Restorative procedures should beperformed on a periodontium free ofinflammation and other sings of

periodontal disease.The restorative margins can be placed

at supragingival, equigingival orsubgingival locations. Supragingivalmargin has the least impact on theperiodontium.

Contd..


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The soft tissue between the base ofthe gingival sulcus to the crest of thealveolar bone is called the biologicwidth which is 2.04 mm.

Ideal contour must provide, access for

hygiene, fullness to create the desiredgingival form and esthetically-pleasingtooth contour.

Four types of pontic designs havebeen proposed sanitary, ridge lap,modified ridge lap and oviate ponticdesigns .

14a periodontal inter-relationship

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