Periodontal Considerations in Restorative Dentistry 1 Flashcards
What are the aims of period tonal therapy
to arrest the disease process
ideally to regenerate lost tissue
to maintain periodontal health long term
What is a good result from periodontal therapy
prevention of tooth loss
How can periodontal therapy act as an aid to restorative dentistry
improves soft tissue management establishes stable gingival margin position contributes to aesthetics reduces tooth mobility informs prognosis
Why is the inflamed gingival margin an issue in restorative dentistry
it bleeds during operative procedures
it is unstable in its apico-coronal location
makes effective restorative dentistry impossible
What is crucial when planning restorations in the aesthetic zone
the position of the GM
When will the position of the gingival margin be stable
when its healthy
If aesthetic demands are high, what should be done
the GM should be monitored for at least 3-6 months after completion of periodontal tx to check that it is stable
once stability is confirmed then place restorations
What are the prosthodontics options for the partially dentate px
FPD with natural abutments
RPD wit natural abutments
implant supported prosthesis
combo of above
What is the damage that can be caused by crowns and bridges
plaque retention
unfavorable transmission of occlusal forces
pulp damage
What does plaque retention from crowns and bridges depend on
location and fit of restoration margins
contours of retainers and poetics
How can damage be caused by an RPT
plaque retention
direct trauma from components
unfavorable transmission of forces (occlusal, insertion and removal)
What does plaque retention from RPD depend on
gingival margin coverage
What type of prosthesis is preferable from a periodontal perspective
fixed prostheses
What are important features of an RPD
effective tooth support
clearance of GM
rigid connector
What is the supracrestal attachment
it is histologically composed of junctional epithelium and supracrestal connective tissue
How much of the restoration margin in the gingival sulcus can you get away with
0.5mm but even then can’t recession
What happens if you put a restoration further than 0.5mm into the sulcus
most likely you are infringing on the supracrestal attachment and this will cause issues
What is important inter proximally
that JE changes position
more coronal now
should bare in mind
What are the possible outcomes if the restoration margins encroach on the supracrestal attachment
persistent inflammation
loss of attachment causing pocketing and recession
How many mm do you need between the restoration margin and bone
3mm
What are issues with overhanging restoration
associated with more inflammation and bone loss than non restored sites
the larger the overhang the greater the bone loss
development of pathogenic flora
What are the keys to periodontally successful indirect restorations
start with healthy tissues
adequate tooth prep according to material
precise margin location
excellent provisional restoration
careful tissue handling and impressions technique
What should we consider when restoring px w periodontitis
what is the prognosis
will more teeth be lost in the future
What is Ante’s law
the combined periodontal area of the abutment teeth should be equal to or greater than the periodontal area of the tooth or teeth to be replaced
What are we afraid of when it comes to abutments in period px
abutments which are periodontally compromis
ed will be overloaded
What is the success of crowns and bridges attributed too
meticulous cause related therapy
compliance with rigorous maintenance programme
careful occlusal design
What are periodontal procedures that can aid restorative dentistry
excessive gingival display (gummy smile)
gingival overgrowth making restorative dentistry impossible
lack of clinical crown height making retention of restoration impossible
camouflage of gingival recession
What are the aspects that lead to soft tissue harmony
gingival health
gingival display
general gingival inclination
gingival outline and symmetry
How can gingival recession be camouflaged
acrylic gingival veneer
