INTERRELATIONSHIP BETWEEN PERIODONTICS AND RESTORATIVE

DENTISTRYPRESENTED BY:

Dr. Superna Tiwari1st year PG

Periodontics

INTRODUCTION

The periodontium is one of the most important anatomic structure of oral cavity in conjugation of fixed prosthodontics.Patient with dental prosthesis require periodontal maintenance at frequent interval because dental prosthesis is susceptible to accumulation of plaque and calculus,especially if margins are placed subgingivally or at the level of gingival margin.To maintain the healyh of periodontium is impoertant and so the various mechanical plaque control methods,which we use regularly,to maintain this state of health.

Periodontal consideration in prosthetic dentistry

Important to treat gingival inflammation or even periodontitis, before prosthetic reconstruction is begun.

However,prognosis of periodontal treatment is rendered questionable by prosthetic treatment that follow it.

negative influence on periodontium

Prothetic construction functional effect phase

Construction phase and their effect

• Rotary intruments

Tooth preparation

• Retraction devices• Elastic impression material• Local gingevectomies or electrosurgery can cause

troughing

Gingival retraction and impression

• Adaptation- rough surface and poorly fitting margin.

Temporary restoration and crown

Funtional effects

The term functional effect refers to the influences cemented restorations may exert on periodontium or gingiva beneath the reconstruction

Funtional effectAttached gingiva

Recession

Subgingival margins

biotypes

Attached gingivaSufficient width is necessary for the

restoration and preservation of periodontal health

If restorative treatment is planned, the goal of treatment is to eliminate periodontal inflammation and to preserve the attached gingiva through adequate plaque control

Adequate width is one that has no negative impact on course and treatment of periodontal disease.

treatmentDenudation of bone to increase the width of

attached gingivaClinical crown lengthening and augmentationApically displaced partial thickness flapConnective tissue graft for augmentation of

keratinised gingiva.

Attached gingiva around abutmentAccording to Maryland & wilson(1979) and

nevins (1986):Attached gingiva should be robust and more

stableIf natural tooth is to be prepared and used as

the part of tooth replacement,the risk must be minimised before placement.

:

• temporary irritation caused by prosthetic treatment will lead to minor clinical problem and original shape will soon be restoredAdequate

width

• Gingival augmentation should be performed before crown placement

• Width around the teeth to be used as a abutment for crown with subgingival margin must be atleast 2-3 mm

Inadequate width

Subgingival restorative marginsSubgingival margin placement can trigger

inflammation & loss of attached gingiva,even if good oral hygiene is maintained

So it is advisable to avoid subgingival crown margin placement

Valderhaug(1980) showed that subgingival crown margin placement is associated with a high risk of gingival recession

He observed 71% of subgingivally placed crown margins were located either supragingivally or at the level of gingival margin 10 years after placement of restoration.

This underlines the difficulty in maintaining long term stability of gingival margin around teeth after subgingival crown margin placement.

Change in: Subgingival margin placement

Supragingival nargin placement

Probing depth 0.5mm unchanged

Mean attachment loss

1.3mm 0.6mm

Maintenance of abutment with deep subgingival crown marginsCurrettes are generally used for subgingival

instrumentation of abutment with subgingival crown margin… these instruments can damage the crown margins and even fracture the margin of ceramic crown.

So at these sites,it may be necessary to limit to professional tooth cleaning to cleaning the tooth surface with gauze and cleaning the sulcus with carefully inserted dental floss.

BiotypeExtend of coronal migration is greater with

thick periodontal biotype(pontoviero &carnevale 2001).

In such patients decision making regarding the placement of crown margin should be delayed until gingival maturation is completed.

maintenancePlaque control is difficult because tip of the

brush cannot be engaged efficiently.The side of the abutment facing the

edentulous space is highly prone to accumulation of plaque, calculus and food.

It is to be hoped that any crown or bridge placed will have life expentancy of atleast a decade and with a high level of maintenance ,restorations are often seen surviving for 20-30 years.

Patient must be educated and motivated to maintain a good oral hygiene.

Method of plaque control should always be tailored to individual needs and ability.

Suitable mirrors and plaque disclosing agents are also helpful.

Maintenance of prosthesis

Healthy

Professional maintenanceSpt every 3-4 months

Scalingpolishing

Home care brushing flossing

interproximal brushesOral rinses

Compromised

Refer to specialistNon surgical treatment