ESTHETIC CONSIDERATION IN GINGIVAL TISSUE: - Interproximal Embrasure form. - Restorative correction of open gingival Embrasure OCCLUSAL CONSIDERATION ROLE OF DENTAL PROSTHESIS RESTORATION OF ROOT RESECTED TOOTH ANTERIOR ESTHETIC SURGERY
Restorative margin should preferably be placed supragingivally.
In case when placement of restorative margin subgingivally is unavoidable due to caries, tooth fracture, previous restoration or aesthetics, it should placed not more then 0.5 mm into the sulcus so that plaque should be achieved.
Radiographic interpretation can identify interproximal violation of biological width.
If patient having discomfort when restorative margins level being assessed with a periodontal probe it is a good indication that the margin extends into the attachment and that a biological width violation occurred.
more positive assessment can be made clinically by measuring the distance between the bone and margin.
The probe is pushed through the anaesthetized attachment tissue from the sulcus to the underlying bones.
If the distance is less than 2mm at one or more location, a diagnosis of biological width violation
Assessment is completed circumferentially around the tooth.
The biological or attachment , width can be identified for each individual patient by probing under anesthesia to the bone level and subtracting the sulcus depth from the resulting measurement.
this measurement must be performed on teeth with healthy gingiva tissue and should be reapeted more than one tooth for accurate measurement.
The information is obtained is then used to definitive diagnose biological width violation.
1.SURGICALLY: By removing bone away from proximity to the restorative margins. Drawback: High risk of inter papillary recession. 2. ORTHODONTICALLY: By extruding the tooth out of the socket. Correction of Biologic-Width Voilation:
By applying low extrusive forces
By rapid orthodontic extrusion
Why the restoration extended sub-gingivally???
For adequate resistance& retention
To make significant contact & contour
To mask the tooth-restoration interface gingivally.
Too Sub-Gingivally located margins may results…..
Proper proximal contact is essential to prevent food impaction.
Forceful wedging of food into interproximal spaces occur due to the funneling effect of adjacent tooth surface directing food interproximally and into open contact areas.
Opposing cusp which force into the proximal area is called plunger cusp.
The mechanical pressure on the interdental tissue can cause ischemia, inflammation, and necrosis of the interdental tissue.
It favours plaque growth and pocket formation.
The contact point should be placed occlusally and buccally to facilitate access for interdental plaque control.
Ideal interproximal embrasure should house the gingival papilla without impinging on it and also extend the interproximal tooth contact to the top of the papilla so that no excess space exist to trap food .
Mainly there are two cause of open gingival embrasure : either the papilla is inadequate in height due to bone loss or interproximal contact is located to high coronally.
If high contact has been dignosed as the cause of the problem ther are two potential reasons either root angulation of tooth diverge or interproximally contact is moved coronally resultig in the open embrasure.
If the root angulation of the tooth diverges -> the interproximal contact is moved coronally -> open embrasure.
If the root are parallel, the papilla form is normal, and open embrasure exists than the problem is related to tooth shape.
Restorative procedure can correct this problem by moving the contact point to the tip of the papilla.
The increases in the utilization of the dental implant and nonmetalic cosmetic restoration has resulted with the increases concern with the force management.
The restoration is the more sensitive with occlusal trauma.
For create good occlusion following point should be follow:
(1) There should be even simultaneous contact on all teeth during centric closure. This distributed the force of closure over all teeth instead of few teeth.
(2) When the mandible moves from centric closure some form of canine or anterior guidance is desirable with on posterior tooth contacts.
(3) The anterior guidance needs to be harmony with the patients neuromuscular envelop of function. Relationship is demonstrated by a lack of framitus and lack of mobility of anterior teeth, patient can speak clearly and comfortably.
(4) The occlusion should be created at a verticle dimension that is stable for the patient.
It is generally accepted that the patient existing vertical dimension is an equilibrium between the eruptive force of their teeth and the repetitive contracted length of their elevator muscle.
(5) When managing a pathological occlusion or when restoring a complete occlusion a repeatable condoler reference position is needed.
Removal partial dentures prepared without occlusal lag tends to shink into edentulous area causing gingival recession of adjacent tooth .
This can be prevented by providing occlusal lag to the clasp.
Fixed prosthesis should be designed to facilitate mechanical plaque control .
For type of pontic design :
Modified ridge lap pontic with concave gingival surface and open interproximal space. Cleaning the undersurface of pontic is difficult in this case, as the pontic makes a surface contact with gingival tissue buccally and lingually.
Lap facing pinpoint contact pontic with open interproximal space.
The pontic makes only a pinpoint contact with ridge and interproximal space are open so the cleansing is easy.
3. Lap facing pinpoint contact pontic with closed interproximal space. 4. Sanitary pontic Contact between the pontic and alveolar mucosa should be restricted to pinpoint as far as possible plaque control.
Development of appropriate contour for hygienic access.
Avoid any excess convexities.
Applied to: Bonded External Appliances Intra Coronal Appliances Indirect Cast Restorations Indication: To prevent mobility
Any inflammation of the periodontal Supporting tissues must be controlled before making a decision for splinting because Inflammation may cause mobility in presence of normal occlusal forces & PDL. Support.