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Restorative aspects of periodontal disease: an update part 2 Nikhil Puri Komal Puri Sujata Surendra Masamatti Vidya Dodwad Dental Update 2024 41:7, 707-709.
Authors
NikhilPuri
MDS
Senior Lecturer, Department of Conservative Dentistry and Endodontics, Institute of Dental Studies and Technologies, Modinagar, Ghaziabad, Uttar Pradesh, India
Along with the biologic considerations regarding crown placement, restorative margin location and implications for soft tissue stability, as explained in the first part of this two part series, there are various restorative dentistry procedures and restorations which, if neglected, may aggravate periodontal disease. This second article describes the surgical techniques for correction of biologic width, correction of interproximal embrasure form, crown preparation and pontic design, and thereafter covers the restorative aspects that may damage the periodontal tissues. Some of the special cases, like splinting, restoration of root resected or bicuspidized tooth, root caries or external resorption cases leading to periodontal tissue damage have also been explained.
Clinical Relevance: Knowledge of the maintenance of the periodontium and how it can be affected by restorative procedures is important for both the clinician and the patient in order to preserve the aesthetics and health of the dentition as a whole.
Article
The preservation of a healthy periodontium is critical for the long-term success of a restored tooth. General dental practitioners (GDPs) must constantly balance the restorative and aesthetic needs of their patients with periodontal health.1 One factor that is of particular importance is the potential damage to the periodontium when the restorative margins are placed subgingivally.
According to Garguilo et al,2 ‘biologic width’ is the zone of the root surface coronal to the alveolar crest, to which the junctional epithelium and connective tissue are attached that averages 2.04 mm in depth; but this may vary from tooth to tooth and is present in all healthy dentition.3 It has been stated in the first part of this series that crown margins, when positioned subgingivally, may be associated with gingival inflammation when in violation of the biologic width, whereas supragingivally located crown margins are associated with the least gingival inflammation. Although supragingival placement of restorative and crown margins may compromise aesthetics to some extent, it allows for ease of impression-taking, cleansing, detection of secondary caries, and is associated with maintainable probing depths.4,5 Subgingival margins, on the other hand, can have damaging effects on the neighbouring hard and soft tissues, especially when they encroach on the junctional epithelium and supracrestal connective tissue,6 and may lead to gingival inflammation, loss of connective tissue attachment and bone resorption.3,7,8
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