restorations and perio health Flashcards
what is the definitions of biological width
the combined width of connective tissue and junctional epithelial attachment formed adjacent to a tooth and superior to the crestal bone.”
what is the equation for biological width
connective tissue attachment + junctional epithelium
what is the approx measurement of the junctional epithelium
0.57-1.14mm
what is the approx measurement of the connective tissue attachment
0.7-1.84mm
what is the importance of biological width
Any violations to it, while providing treatment, will hinder the healthy state of the periodontium resulting in periodontal problems such as gingivitis or periodontitis. Therefore it is important to try and preserve it while providing treatment.
what are the mean dimensions of biological width
2.15mm to 2.30mm
what does biological width do
establishes a healthy state of the periodontium
what issues can occur if the biological width is not maintained
resulting in periodontal problems such as gingivitis or periodontitis.
what are the two main reasons we get perio problems in dentistry
- plaque retentive features
2. food impaction
what sub headings occur under plaque retentive features
created by the shape (3D contour) of the restoration with overhangs or ledges
deficiencies or voids at the margins or in the restoration surface
roughness of the restorative surface causing PRF
WHAT Sub headings occur under food impaction
poor or no contact point
incorrect 3D contour of the supraginigval bulge in the restoration
overbuilt or under built embrasures (spillaways)
what do we clinically need to reproduce in the tooth
the supraginigval bulges which help deflect food deflection
does the incisor canine contact point have a small or large sa
small SA
which contact point has a broad SA
canine- premolar and premolar-molar contact points
what do we need to carry out first
Dietary analysis/ advice & don’t forget smoking cessation
• Oral hygiene procedures (Indices: BOP, PFS, TBI***Tooth brushing and interdental cleaning aids)
• Exposure to and the use of fluoride toothpastes (minimum 1,350 ppm Fluoride twice daily), Fluoride supplements, mouthwashes (essential oils e.g. Listerine) etc.
• Advise on oral hygiene
if food packing inter proximally is an issue what do we need to do
examine the occlusion for
“Plunger cusps” abnormal cusp contact between marginal ridges, not into the normal cusp & fossae arrangement
Open or poor contact points between tooth & restoration(s) or poor embrasure design, leading to the trapping of food
Under built restorations & over erupted antagonist teeth
what do we need to remember before carrying out a restoration
- Teeth are hard tissues held in a vital and dynamic tissue matrix
- Lost hard tissue can be “replaced” with other materials but seldom with results as acceptable as the natural tooth tissues (in terms of contour, surface smoothness, strength, aesthetics, biocompatibility, or longevity)
- Tooth tissue loss may affect the vital supporting hard and soft tissues, in both the shorter and longer terms
what objects can cause iatrogenic damage
incorrect placement of wedges and matrix bands
what can incorrect placement of wedges and matrix bands cause
Gross overhangs (material extrusion) and ledges • Plaque retention, & caries or gingival/periodontal disease
how dow maintain period health and gingival health
correct placement of wedges and matrix band
what can correct placement of wedges and matrix bands allow for
- Tight contact points ; correct vertical positioning of contact points minimise plaque/food trapping ; correct 3D contour of the restoration
- Minimises voids or deficiencies in the restoration resulting in less plaque retention, caries and gingival inflammation
- No overhangs or ledges, or gross material displacement
how can we tell that gingivitis is present when placing the matrix band
Spontaneous haemorrhage on preparation/ when a matrix band or strip is placed
• bleeding prevent adequate moisture control
how can we tell that periodontitis is present when placing the matrix band
Will pocketing and bone loss mean poor restoration contours and aesthetics (“black triangle” disease)
• Deep subgingival floor of the restoration because of root caries
• If so, how deep before sound tissue is found, or the pulp exposed?
what is the long term consequence of gingival and periodontal inflammation 8 things
- Plaque-retaining factor/ plaque with increase in pocket formation, pocket depth with further loss of clinical attachment
- localised alveolar bone loss
- gingival recession
- root caries
- secondary caries at the restoration margin
- associated with poor plaque control/ high consumption of fermentable carbs
- tooth loss and significant alveolar bone remodelling
- aesthetic issues as a result of the restoration margins becoming exposed
what is the clinical relevance
PREVENTION comes FIRST!!
• Check & review baseline gingival/periodontal disease status before starting
• Correctly address any gingival/periodontal disease
• Correct any faulty restorations: refurbish/repair, modify or replace
• Always plan, design, and carry out any restorative treatment by respecting the biological width, natural tooth morphology and anatomical contact relationships
how do we deal with faulty restorations 6 things
Refurbish modify repair refer to specialists leave it? extraction
what do we need to consider if we leave the restoration
if the patient does not want treatment
what features are built into teeth to maintain healthy gums
the supragingival bulge which deflects food buildup
what do we have around the supraginigval bulges
clean stagnation areas
