gingiva and its restorative considerations
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INTRODUCTION
NORMAL GINGIVAIRRITATING FACTORSMARGINS PLACEMENTSGINGIVAL RETRACTION (DEF)
INDICATIONS&CONTRAINDICATIONSPRINCIPLES OF RETRACTIONPHYSICAL MEANSCHEMICAL MEANS
NONCORD RETRACTIONROTARY CURRETAGEELECTRO SURGURYGINGIVAL SULCUS
ENLARGEMENTREFERCENCES
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Improper management of the periodontal tissues
during restorative procedures is common, but
often overlooked cause of failure. When a
restoration is placed, the preservation of an intact,
healthyperiodontium is necessary to maintain the
tooth or teeth being restored. Predictable long-term
restorative success requires acombination of
restorative principles with the correct management
of the periodontal tissues.
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NORMAL GINGIVA PART OF THE ORAL MUCOSA
THAT COVERS THE ALVEOLAR PROCESS OF THE
JAW AND SURROUNDS THE NECK OF THE TEETH.
MARGINAL GINGIVA TERMINAL EDGE OR BORDER
OF THE GINGIVA SURROUNDING TEETH LIKE A
COLLAR. DEMARCATED FROM ADJACENT
ATTACHED GINGIVA BY THE FREE GINGIVALGROOVE. IT IS ABOUT 1 MM WIDE. IT FORMS THE
SOFT TISSUE WALL OF THE GINGIVAL SULCUS.
GINGIVAL SULCUS SHALLOW CREVICE AROUND
THE TOOTH, BOUNDED BY SURFACE OF TOOTH ON
ONE SIDE AND EPITHELIUM LINING THE FREE
MARGIN OF GINGIVA ON THE OTHER. IT IS V-
SHAPED. 2-3MM.
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ATTACHED GINGIVA FIRM, RESILIENT, TIGHTLY BOUND TO
THE UNDERLYING PERIOSTEUM OF ALVEOLAR BONE. FACIAL
ASPECT ETENDS TO RELATIVELY LOOSE AND MOVABLE
ALVEOLAR MUCOSA FROM WHICH IT IS DEMARCATED BY THE
MUCOGINGIVAL JUNCTION.
WIDTH MAILLA MANDIBLE
ANTERIOR 3.! - ".! MM 3.3 - 3.# MM
POSTERIOR 1.# MM 1.$ MM
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are not feasible, restorative margins should be placed at
least 3 mm from the alveolar crest. This dimension allows a
distance of 1 mm for each part of the gingival attachment
(connective tissue attachment and epithelial attachment), for
a total of 2 mm. The additional 1 mm is for a healthy gingival
sulcus.
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INTERDENTAL GINGIVA OCCUPIES THE GINGIVAL
EMBRASSURE WHICH IS THE INTERPROIMAL SPACE
BENEATH THE AREA OF TOOTH CONTACT. IT HAS APYRAMIDAL OR &COL' SHAPE.
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Chronic gingival inflammation around
anterior crowns.
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ROUGHENING OF THE ENAMEL OR DENTIN
()*+
*/0*0
ENHANCES S4 055 06*77*0.
REACTION OF THE PERIODONTIUM
MARGINAL GINIVITIS TO PERIODONTITIS.
MORE SEVERE PERIDONTAL REACTION WITH CARIOGENIC
LOSS OF PHYSIOLOGIC CONTACT 8 CONTOUR OF THE TOOTH.
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SEPERATION OF TEETH SHOULD NOT ECEED THE WIDTH
OF THE PERIDONTAL LIGAMENT SPACE 9%.2 %.! MM:.
IF SEPERATION DOES ECEED THIS, THE PDL WILL BE
COMPRESSED ON ONE SIDE OF THE TOOTH AND TORN ON
THE OTHER SIDE.
FURTHER TRAUMA LEADS TO IREVERSIBLE ISCHAEMIA.
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INTERSEPTAL RUBBER
COMPRESSION ISCHAEMIA OF THE INTERDENTAL GINGIVA
AND FACIAL AND LINGUAL PAPILLAE.
CLAMPS INCORRECTLY CHOSEN OR APPLIED
TRAUMATI;E THE GINGIVA.
DENTAL FLOSS OR TAPE USED TO SEAT INTERDENTAL
RUBBER
LACERATION OR STRANGULATION OF ENTRAPPED GINGIVA.
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VIBRATIONS CAN LEAD TO LACERATION, COMPRESSION,
ISCHAEMIA OF PDL FIBERS, DILACERATION OR CESATION OF
ROOT FORMATION.
BEFORE PREPARING THE PROIMAL PORTION OF ANY
TOOTH, PLACEMENT OF WEDGES APICAL TO CONTACT AREA
WILL ASSURE PROTECTION OF UNDERLYING PERIODONTIUM
FROM THE MECHANICAL AND PHYSICAL TRAUMA OF
INSTRUMENTATION.
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hould be !rm
"nyielding #
$iologically
active
hould properly
%ontour bu&li #Me&di dimension
'or proper
%ontact #
contour
roper contour
c&gi so does not
*+tend apically
roper
tabiliation
$y wedges
To avoid
-aceration # contu&
ion f slipped
apically
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PHYSICAL RETRACTION METHODS
oFORCED PAST THE APICAL ETENT OF THE GINGIVAL CREVICE
oSTRANGULATION OF GINGIVAL TISSUE.
SURFACE LAYER TISSUE COAGULANTS
LEAVE GINGIVA IN STATE OF INFLAMMATION
oWITH SURFACE ULCERATION
oPARTIAL LOSS OF SULCULAR EPITHELIUM.
FLUID COAGULANTS LEAVE GINGIVA IN INFLAMMED STATE.
ELECTROSURGERY LEAVES TISSUES COVERED WITH A COAGULUM
ACCOMPANIED BY MINUTE ULCERATIONS.
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/*0T 'M /%-- -
04 *5T/*M% -M*60$-*
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Mechanical trauma caused
$y repeated insertion
0nd removal of impression
Trays and material.
%atalysts #
%hemical
byproducts of
rubber
$ase elastomeric
mpression
Materials
%ause allergic
reactions.
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RESIDUAL MONOMER.
EOTHERMIC HEAT OF POLYMERI;ATION.
IRRITATING
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hape should beMaintained to
e8ect food0way from
gingiva
rovideMasticatorye9ciency
irect'unctional
'orces along-ong a+is of
tooth
rotectThe
eriodon&tium
revent Tilting#
upra&eruption
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CONTACT TOO BROAD BU-LI 8 OC-GI CHANGES ANATOMY
OF INTERDENTAL COL, INCREASING SURFACE AREA OF
IRRITATION PRONE , NON-KERATINI;ED GINGIVA.CONTACT TOO NARROW, WILL ALLOW ADVERSE VERTICAL
STRESSES AND INVITE FOOD IMPACTION.
CONTACT TOO OCCLUSAL RESULTS IN FLATTENED MR AT
EPENSE OF OCCLUSAL EMBRASSURE.
CONTACT TOO GINGIVAL DIMINISHES GINGIVAL
EMBRASSURE AND EAGGERATES OCCLUSAL EMBRASSURE.
SURFACE FINISH OF RESTORATION IS RELATED TO ITS
CAPACITY TO RETAIN PLA
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GINGIVA TENDS TO RECEDE AS PATIENT MATURES.
SO IN YOUNGER AGE GROUPS, MARGINS SHOULD
BE PLACED IN GREATER PROIMITY TO THE
GINGIVA.
SUB GINGIVAL MARGINS ARE EFFICIENT IN
PROVIDING A MASKING EFFECT OF THERESTORATION PLACED.
HOWEVER OTHER FACTORS MAY ALSO BE
CONSIDERED.
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TOOTH SURFACE FORMING THE WALL OF THE
GINGIVAL CREVICE IS AN AREA RELATIVELYIMMUNE FROM DECAY.
THEREFORE, PLACING A MARGIN SUBGINGIVALLY
COULD IMPART SOME PROTECTION FROM
RECURRENT DECAY IN PATIENTS WITH HIGH
CARIES RATE.
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MORE EFFICIENT PATIENT CONTROLS PLA
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AMALGAM
SUPRAGINGIVAL MARGINS.
SUB GINGIVAL MARGINS INDICATED INCASE OF
HIGH CARIES RATE.
DIRECT TOOTH COLORED REDTORATIONS
MARGINS SHOULD BE PLACED SUPRA GINGIVALLY
AS NONE OF THESE ARE COMPATIBLE WITH THE
PERIODONTIUM.
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CAST RESTORATIONS 8 PORCELAIN RESTORATION
SUBGINGIVAL MARGINS.
NOTE :
IN ANY CASE THE APICAL EXTENT OF THE DECAY IS THE
PRIMARY DECIDING FACTOR IN WHERE TO PLACE THE MARGIN OFTHE RESTORATION.
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OF
cords
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cords
eady made cotton or synthetic woven.
available in di>erent sies.
may be supplied impregnated with chemical
or chemical may be added before or after
insertion in sulcus.
advantage ?non adhesive to the tissues
disadvantage ?di9culty in inserting
into sulcus.
drawn cotton rolls
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soft loose cotton rolls which are readily
rolled into re@uired diameter.
they are then inserted into the sulcus which
is already impregnated or to be impregnated
with chemical.
advantage ?A easily introduced into the
sulcus than cords becauseof its looseness.
A more e9cient than cord ascan incorporate more ofchemical.
disadvantage ?part of coagulated sealingarea on sulcus wall may bepeeled o> initiatingbleeding # 8uid seepage.
cotton pellets
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cotton pellets
used to carry chemical to the already
compacted inserted cord or drawn cotton rolls.
custom temporary restoration
use of bulBy temporary cements liBe inc
o+ide eugenol or non eugenol periodontal
pacB.
can be used in combination with cotton roll.
taBes about 2&3 days.
heavy weight rubber dam
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heavy weight rubber dam
used when multiple teeth isolation is needed.
it has an immediate e>ect.
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$and is marBed on buccal side.
%rimping and adGustments done.
mpression material poured.
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SOLUTION FOR GINGIVAL RETRACTION
/*MT0T% -"T4 ;/%/ %ontains
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"pinephrine #$l and %inc Phenosulfonate.
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Pascord Twisted cord with Aluminum Sulfate
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7/25/2019 Gingiva and Its Restorative Considerations
90/90
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