biologic width
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0.97+1.07=2.04
BIOLOGIC WIDTH-THE NO BREACH ZONE PRESENTED BY: GUIDED BY:
DR. POOJA BHASALE DR. Q.J.A. SHAKIR(PROFESSOR) 1s t YR P.G. STUDENT DR. ARVIND SHETTY(HOD & PROF DR. D.Y. PATIL DENTAL COLLEGE NAVI MUMBAI
WHAT IS BIOLOGIC WIDTH?
INTRODUCTION
Concept of Biologic width is based on studies and analyses by, Gottlieb (1921), Orban and Köhler (1924), and Sicher (1959)
Cinical Periodontology & Implant Dentistry 5th edition Jan Lindhe
INTRODUCTION
Ingber et al(1977) first described “Biologic Width” and credited D.Walter Cohen for first coining the term.
The dimension of biologic width is not constant, it depends on the location of the tooth in the arch, varies from tooth to tooth, and also for each aspect of the tooth.
Its constancy can only be found in healthy dentition.(De Wall etal 1993)
It varies from 0.75 to 4.3mm in length.
SIGNIFICANCE OF BIOLOGIC WIDTH
Biologic width is the nature’s approach for protecting the periodontal ligament and alveolar crest
It acts as a shield which endures trauma, both mechanical and bacterial, to ensure longevity of a tooth and restoration.
Its integrity is indicative of gingival health, and is a guide for restorative procedures.
REASONS FOR BIOLOGIC WIDTH VIOLATION
Attempt to access sound tooth structure Existing caries (Class V ,II ) Resorption defects Traumatic injury (Subgingival fractures) Iatrogenic Improper identification of sulcus depth Injury during tooth preparation Overextended subgingival restorations
J KOIS Periodontology 2000. Val. 11, 1996,29
IMPLICATIONS OF BIOLOGIC WIDTH VIOLATION Persistent Gingival Bone Loss with Inflammation Gingival Recession
Carranza’s Clinical Periodontology 10th edition
THIN AND SCALLOPED
PERIODONTAL BIOTYPE
Gingival Recession Horizontal Bone loss
THICK AND FLAT PERIODONTAL
BIOTYPE
Chronic Gingival InflammationLocalised Gingival Hyperplasia with minimal bone lossIntrabony pocket formation
HOW DO WE IDENTIFY BIOLOGIC WIDTH VIOLATION?
BONE SOUNDING
RADIOGRAPHIC INTERPRETATION
ASSESSING THE RESTORATIVE MARGINS WITH
PROBE
CORRECTING BIOLOGIC WIDTH VIOLATIONS
Can be corrected or prevented by— 1.Surgically removing bone 2.Orthodontic extruding the
tooth
FACTORS DETERMINING THE TREATMENT PROTOCOL
ESTHETICS
GINGIVAL DISPLAY
GINGIVAL CONTOUR
CONDITION OF PERIODONTIUM
ALVEOLAR BONE MORPHOLOGY
WIDTH OF ATTACHED GINGIVA
TOOTH RELATED
POSITION OF TOOTH IN
ARCH
LOCATION OF THE VIOLATION
NUMBER OF TEETH
PRESENT
PRESURGICAL TREATMENT ANALYSIS
Determine the finish line prior to surgery
Bone sounding prior to surgery is performed for establishing the biologic width.
The biologic width requirements will determine the amount of alveolar bone removal
Smukler and Chaibi (1997)
PRESURGICAL TREATMENT ANALYSIS
The combination of biologic width and prosthetic requirements determines the total amount of tooth structure necessary for exposure.
Tooth surface topography, anatomy, and curvature are analyzed for determining
a. Osseous scallop b. Gingival form
Smukler and Chaibi (1997)
DECIDING THE SAFETY LINE Ingber et al (1977) suggested that a minimum
of 3 mm required from the restorative margin to the alveolar crest to permit adequate healing and restoration of the tooth.
Additional 0.5mm of bone removed as safety zone. (Kois1996)
Wagenberg et al.(1989),suggested that atleast 5-5.25mm of tooth structure should be above the osseous crest
Ref: Padbury Jr A, Eber R, Wang H-L.,J Clin Periodontol 2003
FERRULE EFFECT
For post and core restorations
5-6mm of exposed tooth structure
should be present above alveolar
crest
This takes in account the 2mm
ferrule length
Ref: Padbury Jr A, Eber R, Wang H-L.,J Clin Periodontol 2003
SURGICAL CROWN LENGTHENING
Width of Attached
gingiva
Adequate
Flap with Osseous
reduction
Inadequate
Apically Repositioned
Flap with Osseous
Reduction
FLAP WITH OSSEOUS REDUCTION
FLAP WITH OSSEOUS REDUCTION
Atlas of Cosmetic and Reconstructive Periodontal Surgery 3rd edition Cohen
APICALLY REPOSITIONED FLAP WITH OSSEOUS REDUCTION
Atlas of Cosmetic and Reconstructive Periodontal Surgery 3rd edition Cohen
LIMITATIONS OF SURGICAL CROWN LENGTHENING
Gingival recession following osseous reduction.
Loss of interdental papilla Gingival contour of treated
tooth crown higher than adjacent teeth.
Loss of attachment apparatus and recession in the adjacent teeth
Following removal of bony support, an inverse and Unfavorable crown root ratio.
ORTHODONTIC EXTRUSION
Ref:Felippe LA, Monteiro Junior S etal,Quintessence Int. 2003.
Slow orthodontic extrusion force
Rapid orthodontic extrusion with supracrestal fibrotomy
SLOW ORTHODONTIC FORCE EXTRUSION
RAPID ORTHODONTIC EXTRUSION
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