Restorative treatment for periodontal patients 1

Question 1

what are the aims of periodontal therapy

Answer 1

arrest the disease process
regenerate lost tissue
maintain periodontal health long term

prevent tooth loss

Question 2

why is carrying out restorative treatment on periodontal patients difficult

Answer 2

• difficult to achieve a good margin as margins bleed during operative procedures
• unstable as its apico-coronal location

Question 3

when will the position of the gingival margin be stable e

Answer 3

only when the gingivae is healthy

Question 4

what is the minimum time to monitor gingival margins prior to providing restorations post periodontal treatment

Answer 4

minimum 3-6 months

Question 5

what are the prosthetic options for the partially denate patient

Answer 5

• fixed partial denture with natural abutments (bridges)
• RPD
• implant supported prosthesis

Question 6

what damage can fixed restorations cause

Answer 6

• plaque retention
• unfavourable transmission of occlusal forces
• pulp damage

Question 7

what damage can an RPD cause

Answer 7

• plaque retention due to gingival margin coverage
• direct trauma from components
• unfavourable transmission of forces (occlusal, insertion and removal)

Question 8

what is supracrestal attachment (or biologic width)

Answer 8

supracrestal attached tissues are histologically composed of the junctional epithelium and the supracrestal connective tissue attachment

Question 9

what is the width of the supracrestal attachment

Answer 9

2mm but varies between patients and between sites in mouth

Question 10

what happens if you put a restoration into the gingival sulcus

Answer 10

• can just about get away with 0.5mm into sulcus

80% of restorations that have margins in the gingival sulcus will show recession within 5 years

Question 11

what happens if you infringe on the supracrestal attachment when placing a restoration

Answer 11

• persistent inflammation

- loss of attachment (pocketing and recession)

Question 12

how much space do you need between a restoration margin and bone

Answer 12

• 3mm

Question 13

what are they keys to periodontally successful indirect restorations

Answer 13

• start with healthy tissue
• adequate tooth preparation
• precise margin location - don’t destroy papilla
• excellent provisional restorations
• careful tissue handling and impression technique