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PRESENTED BY: Dr.

Superna Tiwari 1st year PG Periodontics

INTRODUCTION
The periodontium is one of the most important anatomic structure of oral cavity in conjugation of fixed prosthodontics. Patient with dental prosthesis require periodontal maintenance at frequent interval because dental prosthesis is susceptible to accumulation of plaque and calculus,especially if margins are placed subgingivally or at the level of gingival margin. To maintain the healyh of periodontium is impoertant and so the various mechanical plaque control methods,which we use regularly,to maintain this state of health.

Periodontal consideration in prosthetic dentistry


Important to treat gingival inflammation or even

periodontitis, before prosthetic reconstruction is begun. However,prognosis of periodontal treatment is rendered questionable by prosthetic treatment that follow it. negative influence on periodontium

Prothetic construction

functional effect

phase

Construction phase and their effect


Tooth preparation Rotary intruments Gingival retraction and impression Retraction devices Elastic impression material Local gingevectomies or electrosurgery can cause troughing Temporary restoration and crown Adaptation- rough surface and poorly fitting margin.

Funtional effects
The term functional effect refers to the influences cemented restorations may exert on periodontium or gingiva beneath the reconstruction

Funtional effect
Attached gingiva Recession

Subgingival margins

biotypes

Attached gingiva
Sufficient width is necessary for the restoration and

preservation of periodontal health If restorative treatment is planned, the goal of treatment is to eliminate periodontal inflammation and to preserve the attached gingiva through adequate plaque control Adequate width is one that has no negative impact on course and treatment of periodontal disease.

treatment
Denudation of bone to increase the width of attached

gingiva Clinical crown lengthening and augmentation Apically displaced partial thickness flap Connective tissue graft for augmentation of keratinised gingiva.

Attached gingiva around abutment


According to Maryland & wilson(1979) and nevins

(1986): Attached gingiva should be robust and more stable If natural tooth is to be prepared and used as the part of tooth replacement,the risk must be minimised before placement.
:

Adequate width Inadequate width

temporary irritation caused by prosthetic treatment will lead to minor clinical problem and original shape will soon be restored

Gingival augmentation should be performed before crown placement Width around the teeth to be used as a abutment for crown with subgingival margin must be atleast 2-3 mm

Subgingival restorative margins


Subgingival margin placement can trigger

inflammation & loss of attached gingiva,even if good oral hygiene is maintained

So it is advisable to avoid subgingival crown margin

placement

Valderhaug(1980) showed that subgingival crown

margin placement is associated with a high risk of gingival recession He observed 71% of subgingivally placed crown margins were located either supragingivally or at the level of gingival margin 10 years after placement of restoration. This underlines the difficulty in maintaining long term stability of gingival margin around teeth after subgingival crown margin placement.

Change in:

Subgingival margin placement 0.5mm

Supragingival nargin placement unchanged

Probing depth

Mean attachment loss

1.3mm

0.6mm

Maintenance of abutment with deep subgingival crown margins


Currettes are generally used for subgingival

instrumentation of abutment with subgingival crown margin these instruments can damage the crown margins and even fracture the margin of ceramic crown. So at these sites,it may be necessary to limit to professional tooth cleaning to cleaning the tooth surface with gauze and cleaning the sulcus with carefully inserted dental floss.

Biotype
Extend of coronal migration is greater with thick

periodontal biotype(pontoviero &carnevale 2001).

In such patients decision making regarding the

placement of crown margin should be delayed until gingival maturation is completed.

maintenance
Plaque control is difficult because tip of the brush

cannot be engaged efficiently. The side of the abutment facing the edentulous space is highly prone to accumulation of plaque, calculus and food.

It is to be hoped that any crown or bridge placed will

have life expentancy of atleast a decade and with a high level of maintenance ,restorations are often seen surviving for 20-30 years. Patient must be educated and motivated to maintain a good oral hygiene. Method of plaque control should always be tailored to individual needs and ability. Suitable mirrors and plaque disclosing agents are also helpful.

Maintenance of prosthesis

Healthy

Compromised

Professional maintenance Spt every 3-4 months Scaling polishing

Home care brushing flossing interproximal brushes Oral rinses Refer to specialist Non surgical treatment