3. Tx Planning II Flashcards
Unsolved periodontal disease leads to what complications for fixed restorations
- Compromises crown longevity
- Complicates execution of procedures (gingival bleeding)
Why should perio issues be addressed before any fixed treatment
-Mobility –> occlusal instability
0Inflammation –> difficulty adjusting proximal contacts
What are the clinical indicators of periodontal disease
bleeding and purulent exudate
What is the importance of having an abundance of attached/keratinized tissue
- Resistant to irritation for restorative procedures and cemented restorations
- Reduces the probability of gingival recession (important in esthetic areas)
- Facilitates impression
Non-keratinized gingiva is more susceptible to….
-inflammation and recession
What is the suggested “adequate”/minimal amount of attached gingiva
2 mm of keratinized and 1 mm of attached gingiva
How can you minimize the probability of recession following restorative treatment
- Gingival tissues should be healthy before beginning restorative procedures
- Adequate band of keratinized tissue and attached gingiva
- Health of tissues is maintained
- Restorative margins don’t extend into the sulcus
- Atraumatic retraction for impression
- Final restoration has optimal contours and marginal fit
Compare and contract the appearance of thick v.s thin gingival biotype
Thick biotype
- Flat osseous and soft tissue architecture
- Dense and fibrous soft tissue
- Ledged or rolled gingival margin
- Resistant to acute trauma
- Larger amounts of attached gingiva
Thin biotype
- Highly scalloped osseous and soft tissue architecture
- Delicate and friable soft tissue
- Knife edge gingival margin
- Reacts to insults with recession
- Smaller amounts of attached gingiva
Clincially how can you tell if someone has thick or thin biotype
If you can see a perio probe through the gingiva it is thin- if not then thick
The biologic width measures _ mm from the bottom of the gingival sulcus to the alveolar bone
2 mm (1 mm CT and 1 mm JE)
What is the total distance from the margin of the crown to the alveolar crest (minimum) if biologic width is not being violated
3 mm
What is the recommended amount of space between the occlusal of the tooth and the alveolar crest
8-9 mm
- 2 mm occlusal reduction
- 3-4 mm axial wall height
- 3 mm margin to alveolar crest
Encroarchment on the biologic width can lead to
chronic tissue irritation
Indications for crown lengthening are
- Preservation of biologic width when restoration margin extends subgingivally
- Enhancing resistance and retention form (short clinical crown)
- Provision of a ferrule effect
- Improved esthetics (gummy smile)
If you want to increase the distance between the crown margin and the alveolar crest the three options are
- Gingivectomy
- Crown lengthening
- Ortho extrusion
How do you decide between doing crown lengthening v.s a gingivectomy?
- Based on zone of keratinized tissue
- Based on sulcus depth
Sulcus depth of 1-2 mm and thin zone of keratinized tissue –> crown lengthening or ortho extrusion
Sulcus depth greater than or equal to 3 and thick zone of keratinized tissue –> gingivectomy
What are the downsides of crown lengthening
- Less favorable crown:root ration
- Diminished bony support of adjacent teeth
- Potential furcation exposure
- Altered esthetic appearance (maxillary anterior)
Mobility is treated based on what
the etiology
Different etiologies of mobility include…
- Gingival and perio inflammation
- Parafunctional occlusal habits
- Occlusal prematurities
- Loss of supporting bone –> poor crown:root ratio
- Traumatic torquing forces applied to clasped teeth by RPD
- Periodontal therapy, endo therapy, ortho therapy
- Trauma
