PERIO-PROSTHOPERIO-PROSTHO
INTERRELATIONSHIPINTERRELATIONSHIP
INDIAN DENTAL ACADEMY
Leader in continuing dental education
...
CONTENTSCONTENTS
 INTRODUCTIONINTRODUCTION
 OBJECTIVES OF PERIODONTAL PROSTHESISOBJECTIVES OF PERIODONTAL PROSTHESIS
 D...
INTRODUCTIONINTRODUCTION
The relationship between periodontal health and theThe relationship between periodontal health an...
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Basic objectives of PeriodontalBasic objectives of Periodontal
ProsthesisProsthesis
1. To reduce lateral stresses1. To red...
DEFINITIONSDEFINITIONS
Oral mucosa consists of 3 zones:Oral mucosa consists of 3 zones:
1.1. masticatory mucosamasticatory...
MARGINAL GINGIVA -MARGINAL GINGIVA -
it is terminal border of gingiva,surrounds teeth in collarit is terminal border of gi...
..
ATTACHED GINGIVA –ATTACHED GINGIVA –
It is firm, resilient and tightly bound to underlyingIt is firm, resilient and tig...
JUNCTIONAL EPITHELIUM:JUNCTIONAL EPITHELIUM:
It is collar like band of non keratinizing epithelium.It is collar like band ...
PERIODONTAL LIGAMENT :PERIODONTAL LIGAMENT :
It consists of principal fibers and elastic fibers.It consists of principal f...
ATTACHMENT UNIT:ATTACHMENT UNIT:
Clinical gingival sulcus depth normally measures 1 to 2 mm,Clinical gingival sulcus depth...
PERIODONTITIS:PERIODONTITIS:
It is inflammatory disease of gingiva and or deeperIt is inflammatory disease of gingiva and ...
GINGIVITIS:GINGIVITIS:
It is defined as inflammation of gingiva, andIt is defined as inflammation of gingiva, and
characte...
There are 4 stages of gingivitisThere are 4 stages of gingivitis
stage 1 : subclinical,2 to 4 days, GCF flowstage 1 : subc...
TRAUMA FROM OCCLUSION:TRAUMA FROM OCCLUSION:
It is defined as a force originating by movement ofIt is defined as a force o...
PERIODONTAL POCKET:PERIODONTAL POCKET:
It is pathologically deepened gingival sulcus, which is one ofIt is pathologically ...
CLASSIFICATION:CLASSIFICATION:
1.1. GINGIVAL POCKET/PSEUDO POCKET-GINGIVAL POCKET/PSEUDO POCKET-
formed by gingival enlarg...
EXAMINATIONEXAMINATION
 VISUAL EXAMINATIONVISUAL EXAMINATION
 ATTACHED GINGIVAATTACHED GINGIVA
 PROBINGPROBING
 MOBILI...
VISUAL EXAMINATIONVISUAL EXAMINATION
IT IS IMPORTANT TO EVALUATE THE COLOR,IT IS IMPORTANT TO EVALUATE THE COLOR,
CONSISTE...
ATTACHED GINGIVAATTACHED GINGIVA
 CROWN MARGINS CAN BE GINGIVAL IRRITANTSCROWN MARGINS CAN BE GINGIVAL IRRITANTS
AND PLAQ...
PROBINGPROBING
 THE THINNEST PROBE IS DESIRED,IT PERMITS NOTHE THINNEST PROBE IS DESIRED,IT PERMITS NO
PATIENT DISCOMFORT...
MOBILITYMOBILITY
 IT IS DETERMINED BY HANDLE OFIT IS DETERMINED BY HANDLE OF
PROBE,PLACED ON BUCCAL AND LINGUALPROBE,PLAC...
RADIOGRAPHSRADIOGRAPHS
 RADIOGRAPHS ARE ESSENTIAL FORRADIOGRAPHS ARE ESSENTIAL FOR
DIAGNOSIS,TREATMENT AND MAINTAINANCE I...
HABITSHABITS
 MAJOR HABIT TO CONSIDER IS BRUXISM.VISUALMAJOR HABIT TO CONSIDER IS BRUXISM.VISUAL
EXAMINATION OF WEAR FACE...
PREPARATION OF TISSUESPREPARATION OF TISSUES
 IT IS IMPORTANT THAT PATIENT IS TO BE INFORMED OFIT IS IMPORTANT THAT PATIE...
Treatment planning:Treatment planning:
 A.A. Initial Preparation :Initial Preparation :
The initial preparation is the te...
 B. Preparation of Oral Tissues:B. Preparation of Oral Tissues:
The second most important aspect is to have patientsThe s...
C. SURGERY:C. SURGERY:
Pocket elimination and establishment of physiologicPocket elimination and establishment of physiolo...
Advanced surgical techniques:Advanced surgical techniques:
1.Mandibular molar can have one root removed – Hemisection1.Man...
Esthetic pre prosthetic surgery:Esthetic pre prosthetic surgery:
1. Management of mucogingival problems (soft tissue autog...
Occlusion and its effect on periodontiumOcclusion and its effect on periodontium
The effect of occlusal forces upon the pe...
Trauma from OcclusionTrauma from Occlusion
 Periodontal injury caused by occlusal forces is called traumaPeriodontal inju...
TFO changes the tissue environment around theTFO changes the tissue environment around the
inflammatory exudates in 2 ways...
Restorative dental procedures and its effect onRestorative dental procedures and its effect on
periodontiumperiodontium
1....
Placement of marginsPlacement of margins
It is most important step in tooth preparation.It influencesIt is most important ...
Supra gingival margin placement:Supra gingival margin placement:
 This is advocated based on the studies that found theTh...
Supragingival margins are easier to prepare accuratelySupragingival margins are easier to prepare accurately
without traum...
Subgingival margin placement /lntracrevicular margins:Subgingival margin placement /lntracrevicular margins:
The term Intr...
 The degree and extent of the marginal inflammation that areThe degree and extent of the marginal inflammation that are
a...
 Improperly finished margins (overhangs or large open margins):Improperly finished margins (overhangs or large open margi...
 Maynard and WilsonMaynard and Wilson suggest that a bandsuggest that a band
of attached gingival of 3 mm width shouldof ...
Biologic width:Biologic width:
 The biologic width is made up of the junctional epithelium and theThe biologic width is m...
Wound Healing considerationWound Healing consideration
 Healing of extensive periodontal surgery usually requires at leas...
7.Properly finished margins7.Properly finished margins
8.Adequate zone of attached gingival8.Adequate zone of attached gin...
Gingival retraction:Gingival retraction:
 Tissue displacement is commonly needed to obtain adequateTissue displacement is...
Types of chemicals used are:Types of chemicals used are:
a) Vasoconstrictors:a) Vasoconstrictors:8% recemic epinephrine8% ...
 Electrosurgery:Electrosurgery:
 Electrosurgery is a surgical procedure performed on soft tissue utilizingElectrosurgery...
 It is contraindicated on or near patient with any electronic medicalIt is contraindicated on or near patient with any el...
Temporary and provisionalTemporary and provisional
coveragecoverage
 Provisional restorations are temporary restorations,...
Cementation:Cementation:
 All intracrevicular margins are checked carefully after cementation for excessAll intracrevicul...
1.Gingival protection theory:1.Gingival protection theory:
 It advocates that contours of restoration be designed toIt ad...
a) Protection of gingival margins:a) Protection of gingival margins:
 This concept implies that under contouring of the c...
2.Muscle action theory: (Morris & Herlands et al)2.Muscle action theory: (Morris & Herlands et al)
19621962..
 They used ...
3.Theory of access for oral hygiene:3.Theory of access for oral hygiene:
This theory is based on the concept that plaqueTh...
Rules for developing crownRules for developing crown
contours in restorationscontours in restorations
 1.Faciolingual cro...
 5.Proximal surfaces between marginal ridges and CEJ5.Proximal surfaces between marginal ridges and CEJ
are flat or sligh...
Occlusal surface:Occlusal surface:
..
 Occlusal surfaces should be designed:Occlusal surfaces should be designed:
>To dir...
Embrasures:Embrasures:
 When teeth are in proximal contact, the spaces that widen out from theWhen teeth are in proximal ...
CrownCrown -- root ratioroot ratio
 Is important in determination of abutments because toothIs important in determination...
 Ideally forces applied to the tooth fall within the periphery of the rootIdeally forces applied to the tooth fall within...
Relationship of pontic adaptation-Relationship of pontic adaptation-
to soft tissue healthto soft tissue health
 The prim...
 Requirements:Requirements:
1.Aesthetically acceptable.1.Aesthetically acceptable.
2.Provide occlusal relationships that ...
Design:Design:
 A pontic should cover only as much of a ridge as is in keeping withA pontic should cover only as much of ...
Modified Ridge lap:Modified Ridge lap:
 Where minimal bone loss exists and esthetics are involved, modifiedWhere minimal ...
Periodontal splints:Periodontal splints:
 A splint, according to the Glossary of Periodontic terms is "anA splint, accord...
 Purposes of splinting are:Purposes of splinting are:
1. Improving form and function of teeth1. Improving form and functi...
 Temporary splinting may or may not be followed withTemporary splinting may or may not be followed with
permanent splinti...
Splinting by bondingSplinting by bonding
 The composite resins have greater strength and light curedThe composite resins ...
Removable splintsRemovable splints
 More rigid connectors are a precision dovetailMore rigid connectors are a precision d...
Restoration of root resectedRestoration of root resected
molarsmolars
 In 1886 G.V, Black termed resection of one or more...
 Contra indications:Contra indications:
1.Systemic conditions prohibiting extensive1.Systemic conditions prohibiting exte...
 Crown preparation:Crown preparation:
Whenever possible, crown margins should beWhenever possible, crown margins should b...
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 Hemisection:Hemisection:
When separating the roots of a mandibular molar, oneWhen separating the roots of a mandibular m...
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 Crown contours:Crown contours:
The gingival 1/3 of the restoration is fabricatedThe gingival 1/3 of the restoration is f...
Conclusion:Conclusion:
 The function and future life of the restorationThe function and future life of the restoration
de...
References:References:
 Tylman's theory and practice of fIxed prosthodontics.Tylman's theory and practice of fIxed prosth...
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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.

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  1. 1. PERIO-PROSTHOPERIO-PROSTHO INTERRELATIONSHIPINTERRELATIONSHIP INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. CONTENTSCONTENTS  INTRODUCTIONINTRODUCTION  OBJECTIVES OF PERIODONTAL PROSTHESISOBJECTIVES OF PERIODONTAL PROSTHESIS  DEFINITIONSDEFINITIONS  EXAMINATIONEXAMINATION  TREATMENT PLANNINGTREATMENT PLANNING  CONCLUSIONCONCLUSION  REFERENCESREFERENCES www.indiandentalacademy.comwww.indiandentalacademy.com
  3. 3. INTRODUCTIONINTRODUCTION The relationship between periodontal health and theThe relationship between periodontal health and the restoration of teeth is intimate and inseparable.Forrestoration of teeth is intimate and inseparable.For restorations to survive long term,the periodontium mustrestorations to survive long term,the periodontium must remain healthy so that the teeth are maintained.For theremain healthy so that the teeth are maintained.For the periodontium to remain healthy,restorations must beperiodontium to remain healthy,restorations must be critically managed in several areas so that they are incritically managed in several areas so that they are in harmony with their surrounding periodontal tissues.harmony with their surrounding periodontal tissues. www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4. www.indiandentalacademy.comwww.indiandentalacademy.com
  5. 5. Basic objectives of PeriodontalBasic objectives of Periodontal ProsthesisProsthesis 1. To reduce lateral stresses1. To reduce lateral stresses 2. To distribute stresses equitably2. To distribute stresses equitably 3. To eliminate areas of food impaction3. To eliminate areas of food impaction 4. To eliminate premature and4. To eliminate premature and //or defective contacts;or defective contacts; elimination of occlusal traumatism - primary or secondary.elimination of occlusal traumatism - primary or secondary. 5. To direct occlusal stresses of functional forces in the long5. To direct occlusal stresses of functional forces in the long axis of the teethaxis of the teeth 6. With the removal of any conflict between joint and teeth6. With the removal of any conflict between joint and teeth during normal function.during normal function. 7. To correct tooth contours7. To correct tooth contours 8. To correct TMJ conditions8. To correct TMJ conditions www.indiandentalacademy.comwww.indiandentalacademy.com
  6. 6. DEFINITIONSDEFINITIONS Oral mucosa consists of 3 zones:Oral mucosa consists of 3 zones: 1.1. masticatory mucosamasticatory mucosa.. 2.2. specialized mucosa.specialized mucosa. 3. lining mucosa.3. lining mucosa. GINGIVAGINGIVA is the part of oral mucosa that coversis the part of oral mucosa that covers the alveolar process of the jaw and surroundsthe alveolar process of the jaw and surrounds the neck of the teeth.the neck of the teeth. It is devided into -It is devided into - marginalmarginal,, attached andattached and interdental gingiva.interdental gingiva.www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7. MARGINAL GINGIVA -MARGINAL GINGIVA - it is terminal border of gingiva,surrounds teeth in collarit is terminal border of gingiva,surrounds teeth in collar like fashion.like fashion. it is 1 mm wide and can be separated by probe.it is 1 mm wide and can be separated by probe. Gingival sulcus -Gingival sulcus - it is shallow space around tooth bounded by surface ofit is shallow space around tooth bounded by surface of tooth on one side and epithelium lining of tooth on othertooth on one side and epithelium lining of tooth on other side.side. Histologically it is 1.8 mm, clinically it is 2 to 3 mmHistologically it is 1.8 mm, clinically it is 2 to 3 mm normally.normally. www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8. .. ATTACHED GINGIVA –ATTACHED GINGIVA – It is firm, resilient and tightly bound to underlyingIt is firm, resilient and tightly bound to underlying periosteum of alveolar bone.periosteum of alveolar bone. Width of attached gingiva is very important parameterWidth of attached gingiva is very important parameter clinically.clinically. INTERDENTAL GINGIVA –INTERDENTAL GINGIVA – It occupies gingival embrassure between area of toothIt occupies gingival embrassure between area of tooth contact.contact. It can be pyramidal or Col shaped. Its valley likeIt can be pyramidal or Col shaped. Its valley like depression that connect facial and lingual papilla.depression that connect facial and lingual papilla. www.indiandentalacademy.comwww.indiandentalacademy.com
  9. 9. JUNCTIONAL EPITHELIUM:JUNCTIONAL EPITHELIUM: It is collar like band of non keratinizing epithelium.It is collar like band of non keratinizing epithelium. 3 to 4 layers thick in early life and increases to 10 to 203 to 4 layers thick in early life and increases to 10 to 20 layers with age.Its length ranges from 0.25-1.35mm.layers with age.Its length ranges from 0.25-1.35mm. very susceptible to infection because of very high turn oververy susceptible to infection because of very high turn over rate of cells.rate of cells. STIPPLING:STIPPLING: It is seen in attached gingiva and centre of interdental papilla,It is seen in attached gingiva and centre of interdental papilla, absent in marginal gingiva.absent in marginal gingiva. www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10. PERIODONTAL LIGAMENT :PERIODONTAL LIGAMENT : It consists of principal fibers and elastic fibers.It consists of principal fibers and elastic fibers. Principal fibers are made of type 1 collagen fibers.Principal fibers are made of type 1 collagen fibers. Elastic fibers are present in 2 immature forms calledElastic fibers are present in 2 immature forms called OXYTALAN and ELAUNIN.OXYTALAN and ELAUNIN. Principal fibers are arranged in 5 groups:Principal fibers are arranged in 5 groups: 1. Transeptal fibers1. Transeptal fibers 2. Alveolar crest fibers2. Alveolar crest fibers 3. Oblique fibers3. Oblique fibers 4. Horizontal fibers4. Horizontal fibers 5. Apical fibers5. Apical fibers 6. Inter radicular fibers6. Inter radicular fibers www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11. ATTACHMENT UNIT:ATTACHMENT UNIT: Clinical gingival sulcus depth normally measures 1 to 2 mm,Clinical gingival sulcus depth normally measures 1 to 2 mm, whereas epithilial attachment is 1mm and the connective tissuewhereas epithilial attachment is 1mm and the connective tissue attachment is 1 mm.attachment is 1 mm. Alveolar crest is therefore located approximately 2mm apical toAlveolar crest is therefore located approximately 2mm apical to the base of the sulcus.the base of the sulcus. PERIODONTAL LIGAMENT :PERIODONTAL LIGAMENT : It is composed of collagen fibres arranged in bundles, that areIt is composed of collagen fibres arranged in bundles, that are attached from the cementum of the tooth to alveolar bone of theattached from the cementum of the tooth to alveolar bone of the jaw.jaw. In healthy mouth it is 0.25 to 0.1mm wide, widest at margin andIn healthy mouth it is 0.25 to 0.1mm wide, widest at margin and apex and narrowest in middle third.apex and narrowest in middle third. www.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12. PERIODONTITIS:PERIODONTITIS: It is inflammatory disease of gingiva and or deeperIt is inflammatory disease of gingiva and or deeper tissues of periodontium and is characterized by pockettissues of periodontium and is characterized by pocket formation and bone destruction.formation and bone destruction. Classification:Classification: 1.1. slowly progressive/chronic/adult periodontitisslowly progressive/chronic/adult periodontitis 2.rapidly progressive periodontitis:2.rapidly progressive periodontitis: a) adult onset periodontitis –prepubertal anda) adult onset periodontitis –prepubertal and juvenilejuvenile b) necrotising ulcerative periodontitisb) necrotising ulcerative periodontitis c) refractory or non responsive periodontitisc) refractory or non responsive periodontitis www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13. GINGIVITIS:GINGIVITIS: It is defined as inflammation of gingiva, andIt is defined as inflammation of gingiva, and characterized by presence of inflammatory cellularcharacterized by presence of inflammatory cellular exudate, edema in gingival lamina propria,exudate, edema in gingival lamina propria, destructions of gingival fibres,ulceration,anddestructions of gingival fibres,ulceration,and proliferation of sulcular epithelium.proliferation of sulcular epithelium. www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14. There are 4 stages of gingivitisThere are 4 stages of gingivitis stage 1 : subclinical,2 to 4 days, GCF flowstage 1 : subclinical,2 to 4 days, GCF flow increasesincreases stage 2 : acute,4 to 7 days, bleeds on probing,stage 2 : acute,4 to 7 days, bleeds on probing, erythemaerythema stage 3 : chronic,2 to 3 weeks, bluish red,stage 3 : chronic,2 to 3 weeks, bluish red, texture changestexture changes stage 4 : advanced, connective tissue breakstage 4 : advanced, connective tissue break down occurdown occur www.indiandentalacademy.comwww.indiandentalacademy.com
  15. 15. TRAUMA FROM OCCLUSION:TRAUMA FROM OCCLUSION: It is defined as a force originating by movement ofIt is defined as a force originating by movement of maxillary and mandibular teeth in a way that createsmaxillary and mandibular teeth in a way that creates a pathological lesion.a pathological lesion. TYPES:TYPES: 1. Primary occlusal trauma1. Primary occlusal trauma 2. Secondary occlusal trauma2. Secondary occlusal trauma www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16. PERIODONTAL POCKET:PERIODONTAL POCKET: It is pathologically deepened gingival sulcus, which is one ofIt is pathologically deepened gingival sulcus, which is one of most important feature of periodontal diseases.most important feature of periodontal diseases. Clinical significance of a pocket is that if it extends beyond 3 toClinical significance of a pocket is that if it extends beyond 3 to 4 mm, patient has difficulty to maintain normal brushing and4 mm, patient has difficulty to maintain normal brushing and flossing.flossing. www.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17. CLASSIFICATION:CLASSIFICATION: 1.1. GINGIVAL POCKET/PSEUDO POCKET-GINGIVAL POCKET/PSEUDO POCKET- formed by gingival enlargementformed by gingival enlargement 2.2. PERIODONTAL POCKETPERIODONTAL POCKET –– occur by destruction of supporting periodontaloccur by destruction of supporting periodontal tissues. It causes loosening of tooth.tissues. It causes loosening of tooth. a)a) Suprabony pocketSuprabony pocket - bottom of pocket is- bottom of pocket is coronal to underlying alveolar bone.coronal to underlying alveolar bone. b)b) Infrabony pocketInfrabony pocket - bottom of pocket is- bottom of pocket is apical to level of adjacent alveolar bone.apical to level of adjacent alveolar bone.www.indiandentalacademy.comwww.indiandentalacademy.com
  18. 18. EXAMINATIONEXAMINATION  VISUAL EXAMINATIONVISUAL EXAMINATION  ATTACHED GINGIVAATTACHED GINGIVA  PROBINGPROBING  MOBILITYMOBILITY  RADIOGRAPHSRADIOGRAPHS  HABITSHABITS  PREPARATION OF TISSUESPREPARATION OF TISSUESwww.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. VISUAL EXAMINATIONVISUAL EXAMINATION IT IS IMPORTANT TO EVALUATE THE COLOR,IT IS IMPORTANT TO EVALUATE THE COLOR, CONSISTENCY,TEXTURE,AND SHAPE OF GINGIVAL UNIT.CONSISTENCY,TEXTURE,AND SHAPE OF GINGIVAL UNIT. IT IS CRITICAL TO RECOGNISE INITIAL STAGE OF MARGINAL LESIONIT IS CRITICAL TO RECOGNISE INITIAL STAGE OF MARGINAL LESION THROUGH THE CHANGE OF COLOR AND CONSISTENCY.THROUGH THE CHANGE OF COLOR AND CONSISTENCY. ADEQUATE LIGHT SOURCE IS ESSENTIAL TO DIFFERENTIATE BITWEENADEQUATE LIGHT SOURCE IS ESSENTIAL TO DIFFERENTIATE BITWEEN NORMAL AND DISEASED TISSUE.NORMAL AND DISEASED TISSUE. A FIBROPTIC UNIT IS USED TO EXAMINE INACCESSIBLE AREAS.A FIBROPTIC UNIT IS USED TO EXAMINE INACCESSIBLE AREAS. www.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20. ATTACHED GINGIVAATTACHED GINGIVA  CROWN MARGINS CAN BE GINGIVAL IRRITANTSCROWN MARGINS CAN BE GINGIVAL IRRITANTS AND PLAQUE TRAPS,SO ENHANCING THEAND PLAQUE TRAPS,SO ENHANCING THE ATTACHED GINGIVA IS ADVISED FORATTACHED GINGIVA IS ADVISED FOR RESTORATIONS.RESTORATIONS.  KERATINISED TISSUE IS OFTEN PRESENT ANDKERATINISED TISSUE IS OFTEN PRESENT AND MISTAKENLY RESTORED, AFTER WHICHMISTAKENLY RESTORED, AFTER WHICH RECESSION CONTINUES.RECESSION CONTINUES. www.indiandentalacademy.comwww.indiandentalacademy.com
  21. 21. PROBINGPROBING  THE THINNEST PROBE IS DESIRED,IT PERMITS NOTHE THINNEST PROBE IS DESIRED,IT PERMITS NO PATIENT DISCOMFORT AND GREATEST EASE INPATIENT DISCOMFORT AND GREATEST EASE IN DIFFERENTIATING THE DIMENSIONS OF POCKET.DIFFERENTIATING THE DIMENSIONS OF POCKET.  THESE PROBES ARE CALLIBERATED IN mm, SHOULD BETHESE PROBES ARE CALLIBERATED IN mm, SHOULD BE PROBED IN 6 AREAS ARROUND THE TOOTHPROBED IN 6 AREAS ARROUND THE TOOTH  IT SHOULD INCLUDE BIFURCATION AND TRIFURCATIONIT SHOULD INCLUDE BIFURCATION AND TRIFURCATION AREAS IN POSTERIOR SEGMENTS.ALSO CHECK FORAREAS IN POSTERIOR SEGMENTS.ALSO CHECK FOR BLEEDING OR EXUDATION AS THESE ARE SIGNS OFBLEEDING OR EXUDATION AS THESE ARE SIGNS OF PERIODONTAL DISEASES.PERIODONTAL DISEASES. www.indiandentalacademy.comwww.indiandentalacademy.com
  22. 22. MOBILITYMOBILITY  IT IS DETERMINED BY HANDLE OFIT IS DETERMINED BY HANDLE OF PROBE,PLACED ON BUCCAL AND LINGUALPROBE,PLACED ON BUCCAL AND LINGUAL SURFACES AND APPLYING PRESSURETO TOOTHSURFACES AND APPLYING PRESSURETO TOOTH WITH HAND.WITH HAND. GRADE 1 - slightly more than normalGRADE 1 - slightly more than normal GRADE 2 - moderately more than normalGRADE 2 - moderately more than normal GRADE 3 - severe mobility faciolingually,GRADE 3 - severe mobility faciolingually, mesiodistally with vertical displacement.mesiodistally with vertical displacement. www.indiandentalacademy.comwww.indiandentalacademy.com
  23. 23. RADIOGRAPHSRADIOGRAPHS  RADIOGRAPHS ARE ESSENTIAL FORRADIOGRAPHS ARE ESSENTIAL FOR DIAGNOSIS,TREATMENT AND MAINTAINANCE INDIAGNOSIS,TREATMENT AND MAINTAINANCE IN PERIODONTICS.PERIODONTICS.  AREAS TO BE REVIEWED ON RADIOGRAPH:AREAS TO BE REVIEWED ON RADIOGRAPH: 1. ALVEOLAR CREST RESORPTION1. ALVEOLAR CREST RESORPTION 2. INTEGRITY OF THICKNESS OF LAMINA DURA2. INTEGRITY OF THICKNESS OF LAMINA DURA 3. EVIDENCE OF HORIZONTAL BONE LOSS3. EVIDENCE OF HORIZONTAL BONE LOSS 4. EVIDENCE OF VERTICAL BONE LOSS4. EVIDENCE OF VERTICAL BONE LOSS 5. WIDENED PERIODONTAL LIGAMENT SPACE5. WIDENED PERIODONTAL LIGAMENT SPACE 6. DENSITY OF TRABECULAE OF BOTH ARCHES6. DENSITY OF TRABECULAE OF BOTH ARCHES 7. SIZE AND SHAPE OF ROOTS COMPARED TO7. SIZE AND SHAPE OF ROOTS COMPARED TO CROWN.CROWN. www.indiandentalacademy.comwww.indiandentalacademy.com
  24. 24. HABITSHABITS  MAJOR HABIT TO CONSIDER IS BRUXISM.VISUALMAJOR HABIT TO CONSIDER IS BRUXISM.VISUAL EXAMINATION OF WEAR FACET PATTERNS ANDEXAMINATION OF WEAR FACET PATTERNS AND RADIOGRAPH OF THICKENED LAMINA DURA AND WIDERADIOGRAPH OF THICKENED LAMINA DURA AND WIDE PERIODONTAL SPACE SHOWS WETHER PATIENT GRINDSPERIODONTAL SPACE SHOWS WETHER PATIENT GRINDS DURING SLEEP.DURING SLEEP.  ONE CONDITION THAT INDICATES BRUXISM IS AONE CONDITION THAT INDICATES BRUXISM IS A COMPLETE ARCH THAT EXHIBITS MOBILITY DESPITECOMPLETE ARCH THAT EXHIBITS MOBILITY DESPITE ADEQUATE OSSEOUS SUPPORT.ADEQUATE OSSEOUS SUPPORT. www.indiandentalacademy.comwww.indiandentalacademy.com
  25. 25. PREPARATION OF TISSUESPREPARATION OF TISSUES  IT IS IMPORTANT THAT PATIENT IS TO BE INFORMED OFIT IS IMPORTANT THAT PATIENT IS TO BE INFORMED OF A PROBLEM AND TO BE EDUCATEDABOUT THAT.AFTERA PROBLEM AND TO BE EDUCATEDABOUT THAT.AFTER THAT FINAL COURSE OF TREATMENT IS DISCUSSEDTHAT FINAL COURSE OF TREATMENT IS DISCUSSED WITH PATIENT.WITH PATIENT.  TREATMENT OBJECTIVES ARE:TREATMENT OBJECTIVES ARE: 1. POCKET ELIMINATION1. POCKET ELIMINATION 2. ESTABLISH PHYSIOLOGIC TISSUE CONTOUR FOR2. ESTABLISH PHYSIOLOGIC TISSUE CONTOUR FOR SELF CLEANSING AND PHYSIOTHERAPEUTICSELF CLEANSING AND PHYSIOTHERAPEUTIC MANAGEMENT.MANAGEMENT. 3. MODIFICATION OF TOOTH MORPHOLOGY TO3. MODIFICATION OF TOOTH MORPHOLOGY TO PROTECT PERIODONTIUM INSULTS.PROTECT PERIODONTIUM INSULTS. 4. ERADICATION OF DYSFUNCTIONAL OCCLUSAL HABITS.4. ERADICATION OF DYSFUNCTIONAL OCCLUSAL HABITS. 5. TOOTH STABILIZATION5. TOOTH STABILIZATION 6. PATIENT CO OPERATION FOR PHYSIOTHRAPEUTICS.6. PATIENT CO OPERATION FOR PHYSIOTHRAPEUTICS. www.indiandentalacademy.comwww.indiandentalacademy.com
  26. 26. Treatment planning:Treatment planning:  A.A. Initial Preparation :Initial Preparation : The initial preparation is the teaching of oral therapeutics.The initial preparation is the teaching of oral therapeutics. Oral Physiotherapy :Oral Physiotherapy : Preparing the patient for maintaining the mouth in a healthyPreparing the patient for maintaining the mouth in a healthy state.state. Increases opportunities for patient education and effectiveIncreases opportunities for patient education and effective dentaldental hygiene.hygiene. www.indiandentalacademy.comwww.indiandentalacademy.com
  27. 27.  B. Preparation of Oral Tissues:B. Preparation of Oral Tissues: The second most important aspect is to have patientsThe second most important aspect is to have patients restore gingival tissues to a healthy condition that canrestore gingival tissues to a healthy condition that can then be maintained with proper instruction.then be maintained with proper instruction. 11) Scaling and currettage) Scaling and currettage 2) Removal of hopelessly involved teeth2) Removal of hopelessly involved teeth 3) Excavation and temporization of caries3) Excavation and temporization of caries 4) Evaluation of teeth for possible endodontic involvement4) Evaluation of teeth for possible endodontic involvement 5) Initiation of orthodontic tooth movement for selective cases5) Initiation of orthodontic tooth movement for selective cases 6) Occlusal Adjustment6) Occlusal Adjustment 7) Fabrication of an acrylic occlusal guard in cases of bruxism7) Fabrication of an acrylic occlusal guard in cases of bruxism 8) Re-evaluation :Done with periodontal probe to record8) Re-evaluation :Done with periodontal probe to record pocket depth and to determine the necessity of surgery.pocket depth and to determine the necessity of surgery.www.indiandentalacademy.comwww.indiandentalacademy.com
  28. 28. C. SURGERY:C. SURGERY: Pocket elimination and establishment of physiologicPocket elimination and establishment of physiologic tissue contours are the prime goals. If scaling andtissue contours are the prime goals. If scaling and curettage have not attained these objectives, surgerycurettage have not attained these objectives, surgery is required.is required. 1.Gingivectomy1.Gingivectomy 2.Microgingival procedure2.Microgingival procedure 3.Mucoperiosteal flap entry with osseous3.Mucoperiosteal flap entry with osseous recontouringrecontouring www.indiandentalacademy.comwww.indiandentalacademy.com
  29. 29. Advanced surgical techniques:Advanced surgical techniques: 1.Mandibular molar can have one root removed – Hemisection1.Mandibular molar can have one root removed – Hemisection 2.On maxillary molars, it is possible to remove the distobuccal2.On maxillary molars, it is possible to remove the distobuccal root or the mesiobuccal root and then to restore this tooth toroot or the mesiobuccal root and then to restore this tooth to function with the tooth splinted to the adjacent tooth.function with the tooth splinted to the adjacent tooth. 3. Bone transplantation - Add bone to the osseous defects3. Bone transplantation - Add bone to the osseous defects accomplished byaccomplished by – Swage procedureSwage procedure – Osseous coagulam proceduresOsseous coagulam procedures – Bone from recent extraction sitesBone from recent extraction sites www.indiandentalacademy.comwww.indiandentalacademy.com
  30. 30. Esthetic pre prosthetic surgery:Esthetic pre prosthetic surgery: 1. Management of mucogingival problems (soft tissue autograph)1. Management of mucogingival problems (soft tissue autograph) 2. Crown lengthening techniques -.2. Crown lengthening techniques -. Correct methods commonly used to achieve additional crown length are:Correct methods commonly used to achieve additional crown length are: - Gingivectomy- Gingivectomy - Apically positioned mucogingival flaps- Apically positioned mucogingival flaps - Osteotomy- Osteotomy - Orthodontic passive or active eruptions- Orthodontic passive or active eruptions 3. Ridge augmentation3. Ridge augmentation:: - To correct excessive loss of bone particularly- To correct excessive loss of bone particularly in the anterior region.in the anterior region. - Replacement of hydroxyapatite- Replacement of hydroxyapatite - Flap surgery- Flap surgery - Mucosal autografts- Mucosal autografts 4. Ridge reduction4. Ridge reduction www.indiandentalacademy.comwww.indiandentalacademy.com
  31. 31. Occlusion and its effect on periodontiumOcclusion and its effect on periodontium The effect of occlusal forces upon the periodontium isThe effect of occlusal forces upon the periodontium is influenced by their:influenced by their: - Severity- Severity - Direction- Direction - Duration- Duration - Frequency- Frequency www.indiandentalacademy.comwww.indiandentalacademy.com
  32. 32. Trauma from OcclusionTrauma from Occlusion  Periodontal injury caused by occlusal forces is called traumaPeriodontal injury caused by occlusal forces is called trauma from occlusion.from occlusion.   TFO occurs in three stages:TFO occurs in three stages: 1. Injury1. Injury 2. Repair2. Repair 3. Change in morphology of the periodontium3. Change in morphology of the periodontium  Injury is produced by excessive occlusal forces.Injury is produced by excessive occlusal forces.  Natural repair of the injury and restoration of periodontal tissuesNatural repair of the injury and restoration of periodontal tissues occur if the force on the tooth diminishes or the tooth driftsoccur if the force on the tooth diminishes or the tooth drifts away from the force (mobility).away from the force (mobility). www.indiandentalacademy.comwww.indiandentalacademy.com
  33. 33. TFO changes the tissue environment around theTFO changes the tissue environment around the inflammatory exudates in 2 ways:inflammatory exudates in 2 ways: 1. It alters the alignment of the transeptal and alveolar crest1. It alters the alignment of the transeptal and alveolar crest fibres and thus changes the direction of the pathway of thefibres and thus changes the direction of the pathway of the inflammation so that it extends directly into the periodontalinflammation so that it extends directly into the periodontal ligaments.ligaments. 2. Excessive occlusal forces produce periodontal ligaments2. Excessive occlusal forces produce periodontal ligaments damage and bone resorption, which aggravate the tissuedamage and bone resorption, which aggravate the tissue destruction, caused by inflammation.destruction, caused by inflammation. www.indiandentalacademy.comwww.indiandentalacademy.com
  34. 34. Restorative dental procedures and its effect onRestorative dental procedures and its effect on periodontiumperiodontium 1. Placement of margin1. Placement of margin 2. Gingival Retraction2. Gingival Retraction 3. Temporary coverage and provisional3. Temporary coverage and provisional restorationrestoration 4. Effect of surface finish of Restoration4. Effect of surface finish of Restoration 5. Cementation5. Cementation www.indiandentalacademy.comwww.indiandentalacademy.com
  35. 35. Placement of marginsPlacement of margins It is most important step in tooth preparation.It influencesIt is most important step in tooth preparation.It influences marginal integrity of restoration.marginal integrity of restoration. a. At the crest of the gingivala. At the crest of the gingival b. Above the gingival crest - supragingivalb. Above the gingival crest - supragingival c. In the intracrevicular space - subgingivalc. In the intracrevicular space - subgingival www.indiandentalacademy.comwww.indiandentalacademy.com
  36. 36. Supra gingival margin placement:Supra gingival margin placement:  This is advocated based on the studies that found theThis is advocated based on the studies that found the subgingival margins are detrimental to periodontal health.subgingival margins are detrimental to periodontal health.  Hunter& Hunter (1990) reported that placing a margin deepHunter& Hunter (1990) reported that placing a margin deep within the gingival crevice is damaging to the periodontium andwithin the gingival crevice is damaging to the periodontium and the problem is compounded with wide seating discrepanciesthe problem is compounded with wide seating discrepancies and cement lines.and cement lines.  Lang (1995) concluded that the margin, the cement, and theLang (1995) concluded that the margin, the cement, and the prepared tooth represent a transition zone that profoundlyprepared tooth represent a transition zone that profoundly affects the ecosystem of the gingival sulcusaffects the ecosystem of the gingival sulcus.. www.indiandentalacademy.comwww.indiandentalacademy.com
  37. 37. Supragingival margins are easier to prepare accuratelySupragingival margins are easier to prepare accurately without trauma to soft tissues. They can usually alsowithout trauma to soft tissues. They can usually also be situated on hard enamel whereas subgingivalbe situated on hard enamel whereas subgingival margins are often on dentine or cementum.margins are often on dentine or cementum.  Advantages:Advantages: >They can be easily finished.>They can be easily finished. >They are more easily kept clean (oral hygiene can>They are more easily kept clean (oral hygiene can be maintained)be maintained) >Impressions are more easily made, with less>Impressions are more easily made, with less potential for soft tissuepotential for soft tissue damage.damage. >Restorations can be easily evaluated at recall>Restorations can be easily evaluated at recall appointments.appointments. www.indiandentalacademy.comwww.indiandentalacademy.com
  38. 38. Subgingival margin placement /lntracrevicular margins:Subgingival margin placement /lntracrevicular margins: The term Intracrevicular for margin placement implies confinement withinThe term Intracrevicular for margin placement implies confinement within the gingival crevice. It is preferable to the term subgingival because sub gingival marginsthe gingival crevice. It is preferable to the term subgingival because sub gingival margins can extend into the functional epithelium and connective tissue, which is a violation of thecan extend into the functional epithelium and connective tissue, which is a violation of the biologic width and results in localized gingival inflammation.biologic width and results in localized gingival inflammation.  Clinical situations in which the margins of the restoration is carried into the gingivalClinical situations in which the margins of the restoration is carried into the gingival sulcus are:sulcus are: 1. Dental caries, cervical erosion or restorations extending subgingivally and a1. Dental caries, cervical erosion or restorations extending subgingivally and a crown lengthening procedure is not indicated.crown lengthening procedure is not indicated. 2. Proximal contact area extends to the gingival crest.2. Proximal contact area extends to the gingival crest. 3. Additional retention is needed.3. Additional retention is needed. 4. Margin of a metal-ceramic crown is to be hidden behind the labiogingival crest.4. Margin of a metal-ceramic crown is to be hidden behind the labiogingival crest. 5. Root sensitivity cannot be controlled by more conservative procedure, such5. Root sensitivity cannot be controlled by more conservative procedure, such as application of dentine bonding agents.as application of dentine bonding agents. 6. Modification of axial contour is indicated.6. Modification of axial contour is indicated.  Subgingival restorative margins are associated with the development of plaqueSubgingival restorative margins are associated with the development of plaque related inflammatory periodontal disease, primarily because of a shift in the subgingivalrelated inflammatory periodontal disease, primarily because of a shift in the subgingival micro flora.micro flora. www.indiandentalacademy.comwww.indiandentalacademy.com
  39. 39.  The degree and extent of the marginal inflammation that areThe degree and extent of the marginal inflammation that are associated withassociated with subgingival margin placement is ,influenced by four factors:subgingival margin placement is ,influenced by four factors: 1. Emergence profile1. Emergence profile 2. Improperly finished margin2. Improperly finished margin 3. Inadequate zone of gingiva3. Inadequate zone of gingiva 4. Violation of biologic width4. Violation of biologic width Emergence profile:Emergence profile: Failure to maintain proper emergence profile may be a result ofFailure to maintain proper emergence profile may be a result of relying on the theory of food deflection when developing crownrelying on the theory of food deflection when developing crown contours, or it may be a result of failure to remove adequate toothcontours, or it may be a result of failure to remove adequate tooth structure during tooth preparation.structure during tooth preparation. Lack of adequate reduction during tooth preparation will necessitateLack of adequate reduction during tooth preparation will necessitate over bulking the final restoration at the gingival margin for adequateover bulking the final restoration at the gingival margin for adequate material strength.material strength. This is particularly true with the porcelain - veneered metal crown.This is particularly true with the porcelain - veneered metal crown. These over contoured restorations change the emergence profile ofThese over contoured restorations change the emergence profile of the tooth. This will create a protected area that encourages plaquethe tooth. This will create a protected area that encourages plaque accumulation and is difficult to clean.accumulation and is difficult to clean.www.indiandentalacademy.comwww.indiandentalacademy.com
  40. 40.  Improperly finished margins (overhangs or large open margins):Improperly finished margins (overhangs or large open margins): Are probably associated with subgingival margins where large number ofAre probably associated with subgingival margins where large number of pathologic microorganisms accumulates. Access to these areas for effectivepathologic microorganisms accumulates. Access to these areas for effective oral hygiene is extremely limitedoral hygiene is extremely limited  inflammatory response.inflammatory response.  Inadequate zone of attached gingiva:Inadequate zone of attached gingiva: Attached gingiva is keratinized and firmly attached to the alveolar bone. AnAttached gingiva is keratinized and firmly attached to the alveolar bone. An adequate gingival band can withstand inadvertent trauma associated withadequate gingival band can withstand inadvertent trauma associated with operative procedures such as tooth preparation, making impression,operative procedures such as tooth preparation, making impression, cementation. Also an adequate zone of attached gingival buffers the freecementation. Also an adequate zone of attached gingival buffers the free gingival margin from the pulling effects of muscle attachments and frena.gingival margin from the pulling effects of muscle attachments and frena. If zone of attached gingival is somewhat less than adequate, margin ofIf zone of attached gingival is somewhat less than adequate, margin of restoration should be kept supragingival whenever possible.restoration should be kept supragingival whenever possible. Introduction of a restorative margin subgingivally with this type of tissue willIntroduction of a restorative margin subgingivally with this type of tissue will have an adverse impact on periodontal health. The result will be a significanthave an adverse impact on periodontal health. The result will be a significant amount of marginal inflammation, followed by subsequent attachment loss andamount of marginal inflammation, followed by subsequent attachment loss and gingival recession. In patients with little or no attached gingival, gingivalgingival recession. In patients with little or no attached gingival, gingival augmentation procedures can be carried.augmentation procedures can be carried. www.indiandentalacademy.comwww.indiandentalacademy.com
  41. 41.  Maynard and WilsonMaynard and Wilson suggest that a bandsuggest that a band of attached gingival of 3 mm width shouldof attached gingival of 3 mm width should be present before subgingival marginbe present before subgingival margin placement is considered.placement is considered.  Violation of the biologic width:Violation of the biologic width: Results in inflammatory marginal lesionResults in inflammatory marginal lesion that will eventually lead to marginalthat will eventually lead to marginal attachment loss.attachment loss. www.indiandentalacademy.comwww.indiandentalacademy.com
  42. 42. Biologic width:Biologic width:  The biologic width is made up of the junctional epithelium and theThe biologic width is made up of the junctional epithelium and the supra alveolar connective tissue found apical to the junctionalsupra alveolar connective tissue found apical to the junctional epithelium.epithelium.  The coronal apical width ranges from 2 to 3mm with approximatelyThe coronal apical width ranges from 2 to 3mm with approximately half composed of junctional epithelium and half of connective. tissuehalf composed of junctional epithelium and half of connective. tissue fibres.fibres.  The coronal half of the gingival sulcus has a much thicker protectiveThe coronal half of the gingival sulcus has a much thicker protective layer of epithelium than does the apical half of the sulcus. Thislayer of epithelium than does the apical half of the sulcus. This coronal region therefore has better resistance to toxic products ofcoronal region therefore has better resistance to toxic products of dental plaque. It is advisable to place restorations in the coronal halfdental plaque. It is advisable to place restorations in the coronal half of the gingival crevice. Thus all subgingival margins should beof the gingival crevice. Thus all subgingival margins should be placed within 1-2 mm of the free gingival margin whenever possible.placed within 1-2 mm of the free gingival margin whenever possible.  Authors reviewing histologic specimens have reported that theAuthors reviewing histologic specimens have reported that the average sulcus depth in a healthy patient was 0.5 mm to 1 mm inaverage sulcus depth in a healthy patient was 0.5 mm to 1 mm in depth. Therefore, the ideal intracrevicular positions for margins aredepth. Therefore, the ideal intracrevicular positions for margins are 0.5 mm beneath the gingival crest. Thus overextension of margin0.5 mm beneath the gingival crest. Thus overextension of margin placement beneath the gingival on root surfaces impinges on theplacement beneath the gingival on root surfaces impinges on the gingival connective tissue fibres and the junctional epitheliumgingival connective tissue fibres and the junctional epithelium www.indiandentalacademy.comwww.indiandentalacademy.com
  43. 43. Wound Healing considerationWound Healing consideration  Healing of extensive periodontal surgery usually requires at least 3Healing of extensive periodontal surgery usually requires at least 3 months. Areas treated by scaling, root planning and plaque controlmonths. Areas treated by scaling, root planning and plaque control without surgery take about 1-2 months for their gingival margins towithout surgery take about 1-2 months for their gingival margins to stabilize.stabilize.  Key to the success for sub gingival margins:Key to the success for sub gingival margins: 1. Achieving optimal preprosthetic gingival health.1. Achieving optimal preprosthetic gingival health. 2.Minimizing gingival trauma from rotary instruments during tooth2.Minimizing gingival trauma from rotary instruments during tooth preparation.preparation. 3.Careful use of gingival retraction cord. The surrounding tissue must3.Careful use of gingival retraction cord. The surrounding tissue must not be permanently damaged during impression making.not be permanently damaged during impression making. 4.Interim restoration should have polished well-fitting and properly4.Interim restoration should have polished well-fitting and properly contoured margins.contoured margins. 5.Cement must not be retained in the gingival crevice.5.Cement must not be retained in the gingival crevice. 6.Intracrevicular plaque control must be sustained throughout the6.Intracrevicular plaque control must be sustained throughout the course of treatment and recall.course of treatment and recall. www.indiandentalacademy.comwww.indiandentalacademy.com
  44. 44. 7.Properly finished margins7.Properly finished margins 8.Adequate zone of attached gingival8.Adequate zone of attached gingival 9.Proper emergence profile9.Proper emergence profile 10.No violation of biologic width10.No violation of biologic width At the crest of marginal gingivaAt the crest of marginal gingiva:: The margins of the preparation are not usually placedThe margins of the preparation are not usually placed at the crest of the marginal gingiva, regardless of howat the crest of the marginal gingiva, regardless of how precise the margins of the restoration. Microscopically,precise the margins of the restoration. Microscopically, the margin is rough and an excellent site to harborthe margin is rough and an excellent site to harbor bacteria since the margin of the gingiva rapidly collectsbacteria since the margin of the gingiva rapidly collects plaque. This is the site of recurrent decay. If decay doesplaque. This is the site of recurrent decay. If decay does not result, the plaque causes periodontal disease at thisnot result, the plaque causes periodontal disease at this most critical area, which is not self-cleansing.most critical area, which is not self-cleansing. www.indiandentalacademy.comwww.indiandentalacademy.com
  45. 45. Gingival retraction:Gingival retraction:  Tissue displacement is commonly needed to obtain adequateTissue displacement is commonly needed to obtain adequate access to the prepared tooth to expose all necessary surfaces, bothaccess to the prepared tooth to expose all necessary surfaces, both prepared and unprepared.prepared and unprepared.  Impressions of intracrevicular finish lines may be extremelyImpressions of intracrevicular finish lines may be extremely injurious to periodontium depending to a great extent on the qualityinjurious to periodontium depending to a great extent on the quality and quantity of attached gingival and type of retraction.and quantity of attached gingival and type of retraction.  All retraction methods induce transient trauma to the junctionalAll retraction methods induce transient trauma to the junctional epithelium and connective tissue of the gingival sulcus.epithelium and connective tissue of the gingival sulcus. Methods of Retraction:Methods of Retraction: 1. Retraction cord1. Retraction cord 2. Electrosurgery2. Electrosurgery 3. Rotary gingival curettage3. Rotary gingival curettage Retraction cord: produce limited gingival recession.Retraction cord: produce limited gingival recession. It is achieved withChemically impregnated cord.It is achieved withChemically impregnated cord. www.indiandentalacademy.comwww.indiandentalacademy.com
  46. 46. Types of chemicals used are:Types of chemicals used are: a) Vasoconstrictors:a) Vasoconstrictors:8% recemic epinephrine8% recemic epinephrine Other chemicals used:Other chemicals used: Aluminium chlorideAluminium chloride Alum (AIKSo4)Alum (AIKSo4) Aluminium sulfate and ferric sulfateAluminium sulfate and ferric sulfate The three criteria for gingival retraction are:The three criteria for gingival retraction are: 1.Effectiveness in gingival displacement and hemostatis1.Effectiveness in gingival displacement and hemostatis 2.Absence of irreversible damage to the gingiva2.Absence of irreversible damage to the gingiva 3.Paucity of untoward systemic effects3.Paucity of untoward systemic effects www.indiandentalacademy.comwww.indiandentalacademy.com
  47. 47.  Electrosurgery:Electrosurgery:  Electrosurgery is a surgical procedure performed on soft tissue utilizingElectrosurgery is a surgical procedure performed on soft tissue utilizing controlled high frequency electrical (radio-frequency) currents in thecontrolled high frequency electrical (radio-frequency) currents in the range of 1,500,000 to 75,00,000 cycles per second.range of 1,500,000 to 75,00,000 cycles per second.  The use of electrosurgery has been recommended for enlargement ofThe use of electrosurgery has been recommended for enlargement of the gingival sulcus to facilitate impression making. In one technique,the gingival sulcus to facilitate impression making. In one technique, the inner epithelial lining of the gingival sulcus is removed, thusthe inner epithelial lining of the gingival sulcus is removed, thus improving access for a subgingival crown margin and effectivelyimproving access for a subgingival crown margin and effectively controlling post surgical hemorrhage.controlling post surgical hemorrhage.  In fixed prosthodontics, electrosurgery is used extensively toIn fixed prosthodontics, electrosurgery is used extensively to adequately expose the subgingival margins of abutment preparationsadequately expose the subgingival margins of abutment preparations for impression procedure. This procedure is known as Troughing.for impression procedure. This procedure is known as Troughing.  Electrosurgery is valuable for smoothening and correcting the contoursElectrosurgery is valuable for smoothening and correcting the contours of edentulous ridges for pontic placement.of edentulous ridges for pontic placement. www.indiandentalacademy.comwww.indiandentalacademy.com
  48. 48.  It is contraindicated on or near patient with any electronic medicalIt is contraindicated on or near patient with any electronic medical device (i.e. cardiac pacemaker, insulin pump) or patients withdevice (i.e. cardiac pacemaker, insulin pump) or patients with delayed healing as a result of debilitating disease or radiationdelayed healing as a result of debilitating disease or radiation therapy.therapy.  It is not suitable on thin attached gingiva e.g. the labial tissue ofIt is not suitable on thin attached gingiva e.g. the labial tissue of maxillary canines (leads to gingival recession).maxillary canines (leads to gingival recession).  It should not be used with metal instruments because contact couldIt should not be used with metal instruments because contact could cause electric shock.cause electric shock. Rotary gingival curettage:Rotary gingival curettage:  The concept of rotary curettage was described by Amsterdam inThe concept of rotary curettage was described by Amsterdam in 1954. Rotary curettage is a 'troughing' technique, the purpose of1954. Rotary curettage is a 'troughing' technique, the purpose of which is to produce limited removal of epithelial tissue in the sulcuswhich is to produce limited removal of epithelial tissue in the sulcus while a chamfer finish line is being created in tooth structure. Thewhile a chamfer finish line is being created in tooth structure. The technique, which also has been called 'gingettage', is used with thetechnique, which also has been called 'gingettage', is used with the subgingival placement of restoration margins.subgingival placement of restoration margins. www.indiandentalacademy.comwww.indiandentalacademy.com
  49. 49. Temporary and provisionalTemporary and provisional coveragecoverage  Provisional restorations are temporary restorations, whichProvisional restorations are temporary restorations, which are placed in the mouth for more than a few days to a feware placed in the mouth for more than a few days to a few months.months.  To facilitate plaque removal, a provisional restoration mustTo facilitate plaque removal, a provisional restoration must have good marginal fit, proper contour and a smoothhave good marginal fit, proper contour and a smooth surface. This is particularly important when the crownsurface. This is particularly important when the crown margin will be placed apical to the free gingival margin.margin will be placed apical to the free gingival margin. The contour of these restorations should also beThe contour of these restorations should also be compatible with the gingival tissues.compatible with the gingival tissues. Effect of surface finish of Restoration:Effect of surface finish of Restoration:  A restoration should have a smooth highly polished orA restoration should have a smooth highly polished or glazed surface. A rough surface retains plaque -leads toglazed surface. A rough surface retains plaque -leads to inflammation.inflammation. www.indiandentalacademy.comwww.indiandentalacademy.com
  50. 50. Cementation:Cementation:  All intracrevicular margins are checked carefully after cementation for excessAll intracrevicular margins are checked carefully after cementation for excess cement. The restoration should be seated as close as possible to the toothcement. The restoration should be seated as close as possible to the tooth preparation. This minimizes the cement line, which enhances plaque formation.preparation. This minimizes the cement line, which enhances plaque formation. The pathogenic flora of the plaque associated with the cement overhangThe pathogenic flora of the plaque associated with the cement overhang causes gingival irritation, violates the periodontal attachment and causes bonecauses gingival irritation, violates the periodontal attachment and causes bone loss.loss. Morphologic characteristics of restoration and Periodontium:Morphologic characteristics of restoration and Periodontium: 1.Contours1.Contours 2.Embrasures2.Embrasures 3.Crown-root ratio3.Crown-root ratio Role of contours in periodontal healthRole of contours in periodontal health:: Three prominent theories of crown contour have evolved:Three prominent theories of crown contour have evolved: 1) Gingival protection theory1) Gingival protection theory 2) Muscle actions2) Muscle actions 3) Access for oral hygiene3) Access for oral hygiene www.indiandentalacademy.comwww.indiandentalacademy.com
  51. 51. 1.Gingival protection theory:1.Gingival protection theory:  It advocates that contours of restoration be designed toIt advocates that contours of restoration be designed to protect marginal gingiva from mechanical injury.protect marginal gingiva from mechanical injury.  Wheeler has remarked that when molars have curvaturesWheeler has remarked that when molars have curvatures in excess of normal, the gingiva will be overprotected andin excess of normal, the gingiva will be overprotected and will suffer from lack of proper stimulation.will suffer from lack of proper stimulation.  The gingival protection theory has been defended primarilyThe gingival protection theory has been defended primarily on the basis of three elements:on the basis of three elements: a) Protection of gingival marginsa) Protection of gingival margins b) Gingival stimulationb) Gingival stimulation c) Self cleansing contoursc) Self cleansing contours www.indiandentalacademy.comwww.indiandentalacademy.com
  52. 52. a) Protection of gingival margins:a) Protection of gingival margins:  This concept implies that under contouring of the crown will causeThis concept implies that under contouring of the crown will cause deflection of masticated food onto the gingival margin, forcing it into thedeflection of masticated food onto the gingival margin, forcing it into the sulcus, thus initiating gingivitis.sulcus, thus initiating gingivitis. b) Gingival stimulation:b) Gingival stimulation:  This concept reasons that, as food is masticated it will pass over theThis concept reasons that, as food is masticated it will pass over the gingiva, stimulating it and causing increased keratinization of thegingiva, stimulating it and causing increased keratinization of the epithelium. The keratinized epithelium would be more resistant toepithelium. The keratinized epithelium would be more resistant to periodontal breakdown.periodontal breakdown. c) Self cleansing contours:c) Self cleansing contours:  This concept asserts that when food passes over the tooth duringThis concept asserts that when food passes over the tooth during mastication, the tooth will be cleansed. Numerous authors have showmastication, the tooth will be cleansed. Numerous authors have show that mastication does not remove plaque at the gingival margin ofthat mastication does not remove plaque at the gingival margin of teeth. Thus, self-cleansing crown contours apparently are nonexistentteeth. Thus, self-cleansing crown contours apparently are nonexistent at the gingival margins of the teeth.at the gingival margins of the teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  53. 53. 2.Muscle action theory: (Morris & Herlands et al)2.Muscle action theory: (Morris & Herlands et al) 19621962..  They used the rationale of muscle molding and cleansing,They used the rationale of muscle molding and cleansing, rather than food impaction to explain the observable clinicalrather than food impaction to explain the observable clinical phenomena found around natural and artificial crowns.phenomena found around natural and artificial crowns.  They suggested that overcontouring prevents the normalThey suggested that overcontouring prevents the normal cleansing action of the musculature and allows food tocleansing action of the musculature and allows food to stagnate in the overprotected sulcus.stagnate in the overprotected sulcus.  This theory promotes constant cleansing and moldingThis theory promotes constant cleansing and molding action by the muscles of the lip, cheek and tongue.action by the muscles of the lip, cheek and tongue. www.indiandentalacademy.comwww.indiandentalacademy.com
  54. 54. 3.Theory of access for oral hygiene:3.Theory of access for oral hygiene: This theory is based on the concept that plaqueThis theory is based on the concept that plaque is the prime etiologic factor in caries and gingivitis. Thusis the prime etiologic factor in caries and gingivitis. Thus crown contours should facilitate plaque removal, notcrown contours should facilitate plaque removal, not hinder it. One study showed that an increase inhinder it. One study showed that an increase in periodontal inflammation when crowns were overperiodontal inflammation when crowns were over contoured due to decreased access for oral hygiene.contoured due to decreased access for oral hygiene. Four guidelines to contouring crowns withFour guidelines to contouring crowns with emphasis on access for oral hygiene will be described.emphasis on access for oral hygiene will be described. 1.Buccal and lingual contours: flat not fat!1.Buccal and lingual contours: flat not fat! 2.Open embrasure2.Open embrasure 3.Location- of contactar areas3.Location- of contactar areas 4.Furcation invoIvement4.Furcation invoIvement www.indiandentalacademy.comwww.indiandentalacademy.com
  55. 55. Rules for developing crownRules for developing crown contours in restorationscontours in restorations  1.Faciolingual crown dimensions no more than 1 mm1.Faciolingual crown dimensions no more than 1 mm larger than the facio lingual width at level of the CEJ.larger than the facio lingual width at level of the CEJ. Possible exception – mandibular molar and secondPossible exception – mandibular molar and second remolars.remolars.  2.Facial contours are found in gingival third of the crown2.Facial contours are found in gingival third of the crown and should notand should not bulge more than ½ mm beyond CEJ.bulge more than ½ mm beyond CEJ.  3.Lingual contours greatest convexity at gingival third3.Lingual contours greatest convexity at gingival third and should not protrude more than 0.5 mm lingual.and should not protrude more than 0.5 mm lingual.  4.Proximal contact points are in the occlusal third of the4.Proximal contact points are in the occlusal third of the crown. Maxillary molars may be at level of junction ofcrown. Maxillary molars may be at level of junction of occlusal third and middle third. Proximal contact pointsocclusal third and middle third. Proximal contact points are buccal to the central fossa line except for maxillaryare buccal to the central fossa line except for maxillary molars found at middle third.molars found at middle third. www.indiandentalacademy.comwww.indiandentalacademy.com
  56. 56.  5.Proximal surfaces between marginal ridges and CEJ5.Proximal surfaces between marginal ridges and CEJ are flat or slightly concave buccolingually.are flat or slightly concave buccolingually.  6.Axial transitional line angles are straight between the6.Axial transitional line angles are straight between the proximal contact point and the CEJ.proximal contact point and the CEJ.  7.Marginal ridges should be the same height. The facial7.Marginal ridges should be the same height. The facial ½ of any tooth is wider than the lingual. Lingual½ of any tooth is wider than the lingual. Lingual embrasures are always larger than buccal embrasuresembrasures are always larger than buccal embrasures when curved occlusally.when curved occlusally.  8.Crown margin - gingival relationship: Margin should be8.Crown margin - gingival relationship: Margin should be coronal to gingivaexcept for esthetics, crown length, rootcoronal to gingivaexcept for esthetics, crown length, root caries, root sensitivity and existing restorations.caries, root sensitivity and existing restorations. www.indiandentalacademy.comwww.indiandentalacademy.com
  57. 57. Occlusal surface:Occlusal surface: ..  Occlusal surfaces should be designed:Occlusal surfaces should be designed: >To direct masticatory force~ along the long axis>To direct masticatory force~ along the long axis of tooth.of tooth. >To restore occlusal dimensions and cuspal>To restore occlusal dimensions and cuspal contours in harmony with the remainder of thecontours in harmony with the remainder of the natural dentition.natural dentition. >The anatomy of the occlusal surface should>The anatomy of the occlusal surface should provide well-formed marginal ridges and occlusalprovide well-formed marginal ridges and occlusal sluiceways to prevent interproximal food impactionsluiceways to prevent interproximal food impaction www.indiandentalacademy.comwww.indiandentalacademy.com
  58. 58. Embrasures:Embrasures:  When teeth are in proximal contact, the spaces that widen out from theWhen teeth are in proximal contact, the spaces that widen out from the contact area are known as embrasures.contact area are known as embrasures.  The following dimensions of gingival embrasure more important to preservationThe following dimensions of gingival embrasure more important to preservation of gingival health are:of gingival health are: 1. Height: Distance between contact area and bone margin.1. Height: Distance between contact area and bone margin. 2. Width: Distance mesiodistally between proximal surfaces.2. Width: Distance mesiodistally between proximal surfaces. 3. Depth: Distance faciolingually from contact area joining proximofacial or3. Depth: Distance faciolingually from contact area joining proximofacial or proximolingual line angles.proximolingual line angles.  Embrasures protect the gingiva from food impaction and deflect the food toEmbrasures protect the gingiva from food impaction and deflect the food to massage the gingival surface. They provide spillways for food duringmassage the gingival surface. They provide spillways for food during mastication and relieve occlusal forces when resistant food is chewed. Themastication and relieve occlusal forces when resistant food is chewed. The proximal surfaces of the crown should taper away from the contact areas on allproximal surfaces of the crown should taper away from the contact areas on all surfaces.surfaces.  Proximal contacts that are narrow buccolingually create enlarged embrasuresProximal contacts that are narrow buccolingually create enlarged embrasures without sufficient protection against interdental food impaction.without sufficient protection against interdental food impaction. Broad contact area: suppress gingival papillae inflammationBroad contact area: suppress gingival papillae inflammation www.indiandentalacademy.comwww.indiandentalacademy.com
  59. 59. CrownCrown -- root ratioroot ratio  Is important in determination of abutments because toothIs important in determination of abutments because tooth stability is influenced by the leverage exerted upon thestability is influenced by the leverage exerted upon the periodontium. The nature of this leverage depends on theperiodontium. The nature of this leverage depends on the amount of tooth retained in bone i.e. clinical root. Increaseamount of tooth retained in bone i.e. clinical root. Increase in the length of the crown create unfavorable leveragein the length of the crown create unfavorable leverage upon the periodontium.upon the periodontium.  There are 2 methods of modifying the tooth form to changeThere are 2 methods of modifying the tooth form to change the unfavorable crown to root ratio:the unfavorable crown to root ratio: 1.Construction of a complete crown (cast)1.Construction of a complete crown (cast) 2.Change the occlusal surface of the tooth with an onlay.2.Change the occlusal surface of the tooth with an onlay.  Lateral and tipping stresses arise during function when the cuspalLateral and tipping stresses arise during function when the cuspal inclines are steep or the occlusal topography is too broad.inclines are steep or the occlusal topography is too broad. www.indiandentalacademy.comwww.indiandentalacademy.com
  60. 60.  Ideally forces applied to the tooth fall within the periphery of the rootIdeally forces applied to the tooth fall within the periphery of the root structure in bone. If the direction of the functional forces falls within thestructure in bone. If the direction of the functional forces falls within the lateral borders of the clinical root, stress is directed vertically upon thelateral borders of the clinical root, stress is directed vertically upon the periodontium. Conversely, if the force is directed beyond the confinesperiodontium. Conversely, if the force is directed beyond the confines of the root, tipping stresses are induced.of the root, tipping stresses are induced.  Narrowing the buccolingual width of the occlusal surfaces ofNarrowing the buccolingual width of the occlusal surfaces of thethe reconstructed crown encourages a more desirable location for thereconstructed crown encourages a more desirable location for the mandibular buccal and maxillary lingual cusps in relation to the root.mandibular buccal and maxillary lingual cusps in relation to the root.  The crown - root ratio is a measure of length of the toothThe crown - root ratio is a measure of length of the tooth occlusal to alveolar crest of bone compared to the length orocclusal to alveolar crest of bone compared to the length or the root embedded in the bone. Evaluation is bestthe root embedded in the bone. Evaluation is best performed using the clinical crown to root ratio.performed using the clinical crown to root ratio.  A ratio of 1:2 was considered ideal, 1: 1.5 acceptable andA ratio of 1:2 was considered ideal, 1: 1.5 acceptable and 1: 1 – minimal1: 1 – minimal www.indiandentalacademy.comwww.indiandentalacademy.com
  61. 61. Relationship of pontic adaptation-Relationship of pontic adaptation- to soft tissue healthto soft tissue health  The primary purpose of a pontic is to substituteThe primary purpose of a pontic is to substitute for a missing tooth. The manner in which thefor a missing tooth. The manner in which the pontic is designed and adapted to the soft tissuepontic is designed and adapted to the soft tissue of the edentulous ridge determines whether theof the edentulous ridge determines whether the surrounding tissues will remain healthy or becomesurrounding tissues will remain healthy or become diseased.diseased.  Of prime concern in this region are the degreeOf prime concern in this region are the degree of pressure, the area of ridge contact and theof pressure, the area of ridge contact and the embrasure space between the abutment tooth andembrasure space between the abutment tooth and pontic. Due consideration must be given to thesepontic. Due consideration must be given to these three factors if good tissue tolerance to ponticthree factors if good tissue tolerance to pontic placement is to be expected.placement is to be expected. www.indiandentalacademy.comwww.indiandentalacademy.com
  62. 62.  Requirements:Requirements: 1.Aesthetically acceptable.1.Aesthetically acceptable. 2.Provide occlusal relationships that are favorable to the2.Provide occlusal relationships that are favorable to the abutment teeth and opposing teeth and remainder ofabutment teeth and opposing teeth and remainder of the dentition.the dentition. 3.Restore masticatory effectiveness of the tooth it3.Restore masticatory effectiveness of the tooth it replaces.replaces. 4.Designed to minimize accumulation of dental plaque4.Designed to minimize accumulation of dental plaque and food debris and permit access for cleansing by patient.and food debris and permit access for cleansing by patient. 5.Provide embrasures for passage of food. Minimal5.Provide embrasures for passage of food. Minimal passive contact with the ridge and should not blanch thepassive contact with the ridge and should not blanch the tissues.tissues. www.indiandentalacademy.comwww.indiandentalacademy.com
  63. 63. Design:Design:  A pontic should cover only as much of a ridge as is in keeping withA pontic should cover only as much of a ridge as is in keeping with esthetics and comfort. Excessive ridge lapping seriously frustratesesthetics and comfort. Excessive ridge lapping seriously frustrates proper cleansing and should be avoided.proper cleansing and should be avoided.  The gingival surface that contacts the ridge should have highlyThe gingival surface that contacts the ridge should have highly glazed porcelain as the material of choice. Rough surfaces accumulateglazed porcelain as the material of choice. Rough surfaces accumulate plaque and cause irritation.plaque and cause irritation. Sanitary or Hygienic Pontic:Sanitary or Hygienic Pontic:  The term hygienic is used to describe pontics that have no contactThe term hygienic is used to describe pontics that have no contact with the edentulous ridge. These should be at least 3 mm of spacewith the edentulous ridge. These should be at least 3 mm of space between the pontic and the ridge so that the patient can maintainbetween the pontic and the ridge so that the patient can maintain hygiene and this allows the tongue and cheek to remove any foodhygiene and this allows the tongue and cheek to remove any food particles that may lodge in this area. Where esthetics is not or primeparticles that may lodge in this area. Where esthetics is not or prime concern, this pontic is the design of choice. Less than 2 mm spaceconcern, this pontic is the design of choice. Less than 2 mm space causes food entrapment.causes food entrapment. www.indiandentalacademy.comwww.indiandentalacademy.com
  64. 64. Modified Ridge lap:Modified Ridge lap:  Where minimal bone loss exists and esthetics are involved, modifiedWhere minimal bone loss exists and esthetics are involved, modified ridge lap is the preferable design. It contacts only the buccal surface ofridge lap is the preferable design. It contacts only the buccal surface of the ridge. It should have only minimal passive contact with the ridge.the ridge. It should have only minimal passive contact with the ridge. Research has confirmed that excessive pressure causes inflammationResearch has confirmed that excessive pressure causes inflammation and proliferation of the tissue. The pontic should not blanch the tissue.and proliferation of the tissue. The pontic should not blanch the tissue.  The lingual surface should have a slight deflective contour to preventThe lingual surface should have a slight deflective contour to prevent food impaction and minimize plaque accumulation. Ridge contact mustfood impaction and minimize plaque accumulation. Ridge contact must extend no further lingually than the midline of the edentulous ridge.extend no further lingually than the midline of the edentulous ridge. Saddle PonticSaddle Pontic // Ridge Lap:Ridge Lap:  The saddle pontic has a concave fitting surface that overlaps theThe saddle pontic has a concave fitting surface that overlaps the residual ridge buccolingually. However, saddle designs should beresidual ridge buccolingually. However, saddle designs should be avoided because the concave gingival surface of the pontic is notavoided because the concave gingival surface of the pontic is not accessible to cleaning with dental floss, which will lead to plaqueaccessible to cleaning with dental floss, which will lead to plaque accumulation. This design deficiency has been shown to result inaccumulation. This design deficiency has been shown to result in tissue inflammation.tissue inflammation. www.indiandentalacademy.comwww.indiandentalacademy.com
  65. 65. Periodontal splints:Periodontal splints:  A splint, according to the Glossary of Periodontic terms is "anA splint, according to the Glossary of Periodontic terms is "an appliance designed to stabilize teeth". A splint can be fabricated in theappliance designed to stabilize teeth". A splint can be fabricated in the form of joined composite fillings, fixed bridges, removable partialform of joined composite fillings, fixed bridges, removable partial prosthesis etc.prosthesis etc.  The purpose of the splint should be to distribute and direct theThe purpose of the splint should be to distribute and direct the functional and functional forces, to bring them within the tolerance offunctional and functional forces, to bring them within the tolerance of the remaining supporting tissues and to eliminate any mobility that maythe remaining supporting tissues and to eliminate any mobility that may be present. Fixation provides mechanical advantage andbe present. Fixation provides mechanical advantage and simultaneously restricts excessive tooth movements.simultaneously restricts excessive tooth movements. The primary purposes of splinting are:The primary purposes of splinting are: 1. Stabilization1. Stabilization 2. Reorientation of force and stress - the unit area of resistance to2. Reorientation of force and stress - the unit area of resistance to force and stress is increased.force and stress is increased. www.indiandentalacademy.comwww.indiandentalacademy.com
  66. 66.  Purposes of splinting are:Purposes of splinting are: 1. Improving form and function of teeth1. Improving form and function of teeth 2. Modifying occlusal contact patterns2. Modifying occlusal contact patterns 3. Adjustment of jaw relations3. Adjustment of jaw relations 4. Improvement of masticatory efficiency.4. Improvement of masticatory efficiency.  Unilateral splinting is the joining of 2 or more teeth in one plane of anUnilateral splinting is the joining of 2 or more teeth in one plane of an arch segment. Bilateral splinting or cross-arch splinting involves thearch segment. Bilateral splinting or cross-arch splinting involves the inclusion of teeth on 2 or more segments of an arch up to and includinginclusion of teeth on 2 or more segments of an arch up to and including the entire arch.the entire arch.  Splinting Methods:Splinting Methods: 1. Temporary1. Temporary // ReversibleReversible 2. Provisional2. Provisional 3. Permanent3. Permanent www.indiandentalacademy.comwww.indiandentalacademy.com
  67. 67.  Temporary splinting may or may not be followed withTemporary splinting may or may not be followed with permanent splinting. Some methods of reversiblepermanent splinting. Some methods of reversible splinting are:splinting are: a)Ligature wirea)Ligature wire b)Circumferential wiringb)Circumferential wiring c)Removable appliances (Hawley's bite planes)c)Removable appliances (Hawley's bite planes) d)Bondingd)Bonding  The first 2 methods are rarely used and involveThe first 2 methods are rarely used and involve wrapping wire around the teeth, tying it in an intricatewrapping wire around the teeth, tying it in an intricate fashion and then covering it with acrylic.fashion and then covering it with acrylic.  Removable appliances include Hawley's Retainer and aRemovable appliances include Hawley's Retainer and a continuous clasp (R.P.D.).continuous clasp (R.P.D.). www.indiandentalacademy.comwww.indiandentalacademy.com
  68. 68. Splinting by bondingSplinting by bonding  The composite resins have greater strength and light curedThe composite resins have greater strength and light cured bonding permits better control of contours. Temporarybonding permits better control of contours. Temporary splinting is accomplished with the composite material alonesplinting is accomplished with the composite material alone or in combination with extracoronal and intracoronal oror in combination with extracoronal and intracoronal or screen meshes.screen meshes.  Provisional splinting with full-coverage acrylics:Provisional splinting with full-coverage acrylics: >This method is commonly used with periodontally>This method is commonly used with periodontally compromised patients where there is a commitment tocompromised patients where there is a commitment to fixed splints after periodontal therapy.fixed splints after periodontal therapy. >Before periodontal treatment,teeth are prepared and heat>Before periodontal treatment,teeth are prepared and heat processed acrylic treatment restorations are constructedprocessed acrylic treatment restorations are constructed and cemented with sedative cements.and cemented with sedative cements. www.indiandentalacademy.comwww.indiandentalacademy.com
  69. 69. Removable splintsRemovable splints  More rigid connectors are a precision dovetailMore rigid connectors are a precision dovetail lock design occupying more embrasure spacelock design occupying more embrasure space buccolingually and occlusogingivally than castbuccolingually and occlusogingivally than cast rigid connector. Broken stress connectors arerigid connector. Broken stress connectors are indicated when tooth malalignment prevents aindicated when tooth malalignment prevents a common path of insertion.They allow designcommon path of insertion.They allow design flexibility.flexibility.  The keyway should be on the distal surface ofThe keyway should be on the distal surface of the abutment crown, with the key on the mesialthe abutment crown, with the key on the mesial surface of the adjacent pontic. This arrangementsurface of the adjacent pontic. This arrangement encourages mesial drift to seal the key in the keyencourages mesial drift to seal the key in the key way of the connector.way of the connector. www.indiandentalacademy.comwww.indiandentalacademy.com
  70. 70. Restoration of root resectedRestoration of root resected molarsmolars  In 1886 G.V, Black termed resection of one or more roots "radectomy".In 1886 G.V, Black termed resection of one or more roots "radectomy". The terminology for the various approaches in resecting the differentThe terminology for the various approaches in resecting the different roots is far from uniform and very confusing.roots is far from uniform and very confusing.  According to GPT:According to GPT: Root amputation: The removal of a root from a multirooted tooth.Root amputation: The removal of a root from a multirooted tooth. Root resection: Surgical removal of all or a portion of the root beforeRoot resection: Surgical removal of all or a portion of the root before or after endodontic treatment.or after endodontic treatment. Hemisection: Surgical separation of a multirooted tooth through theHemisection: Surgical separation of a multirooted tooth through the furcation area in such a way that a root or roots may be surgicallyfurcation area in such a way that a root or roots may be surgically removed along with the associated portion of crown.removed along with the associated portion of crown.  Indications:Indications: 1.Vertical bone loss around one root but not others.1.Vertical bone loss around one root but not others. 2.Furcation invasions with limited vertical bone loss around roots to be2.Furcation invasions with limited vertical bone loss around roots to be retained.retained. 3.Fracture in the middle or apical one third of root.3.Fracture in the middle or apical one third of root. 4.Caries or unrestorable tooth structure into the furcation.4.Caries or unrestorable tooth structure into the furcation. 5.Root sensitivity5.Root sensitivity 6.A root with untreatable apical lesion6.A root with untreatable apical lesionwww.indiandentalacademy.comwww.indiandentalacademy.com
  71. 71.  Contra indications:Contra indications: 1.Systemic conditions prohibiting extensive1.Systemic conditions prohibiting extensive dental procedures.dental procedures. 2.Inadequate bone support or unfavorable2.Inadequate bone support or unfavorable crown root ratio of retained rootscrown root ratio of retained roots 3.Periodontal therapy that cannot produce3.Periodontal therapy that cannot produce an acceptable gingival architecture withoutan acceptable gingival architecture without removing supportive bone from adjacentremoving supportive bone from adjacent teeth.teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  72. 72.  Crown preparation:Crown preparation: Whenever possible, crown margins should beWhenever possible, crown margins should be placed supragingivally for ease of impressions,placed supragingivally for ease of impressions, margin finishing and overall periodontal health.margin finishing and overall periodontal health. Intracrevicular margin placement may be requiredIntracrevicular margin placement may be required to cover portions of the root-resected area.to cover portions of the root-resected area. The crown margin should be apical to the pulpThe crown margin should be apical to the pulp chamber floor or root canal that was exposed bychamber floor or root canal that was exposed by resection.resection. www.indiandentalacademy.comwww.indiandentalacademy.com
  73. 73. www.indiandentalacademy.comwww.indiandentalacademy.com
  74. 74.  Hemisection:Hemisection: When separating the roots of a mandibular molar, oneWhen separating the roots of a mandibular molar, one root is removed while the other remains. Saving the mesialroot is removed while the other remains. Saving the mesial root would be desirable, if the molar where the last tooth inroot would be desirable, if the molar where the last tooth in the arch. The distal root could be used in an abutment for athe arch. The distal root could be used in an abutment for a short span FPD replacing mesial root.short span FPD replacing mesial root. If an effort is made to save both roots of the molarIf an effort is made to save both roots of the molar following the resection the process is describedfollowing the resection the process is described bicuspidizationbicuspidization. If both roots are maintained, it is. If both roots are maintained, it is important that they be separated from each other to allowimportant that they be separated from each other to allow normal gingival embrasure spaces and may be restorednormal gingival embrasure spaces and may be restored with individual crowns.with individual crowns. www.indiandentalacademy.comwww.indiandentalacademy.com
  75. 75. www.indiandentalacademy.comwww.indiandentalacademy.com
  76. 76.  Crown contours:Crown contours: The gingival 1/3 of the restoration is fabricatedThe gingival 1/3 of the restoration is fabricated with a flat emergence profile from the gingiva towith a flat emergence profile from the gingiva to facilitate oral hygiene.facilitate oral hygiene.  Occlusion:Occlusion: Lateral forces are controlled by minimizingLateral forces are controlled by minimizing cuspal inclines on the resected molar and thecuspal inclines on the resected molar and the teeth stabilizing it.teeth stabilizing it. www.indiandentalacademy.comwww.indiandentalacademy.com
  77. 77. Conclusion:Conclusion:  The function and future life of the restorationThe function and future life of the restoration depend upon the preservation of the epithelialdepend upon the preservation of the epithelial attachment and the normal form of the crown-attachment and the normal form of the crown- physiologic form and function.physiologic form and function. www.indiandentalacademy.comwww.indiandentalacademy.com
  78. 78. References:References:  Tylman's theory and practice of fIxed prosthodontics.Tylman's theory and practice of fIxed prosthodontics.  Glickman's clinical periodontologyGlickman's clinical periodontology  Dental maintainance for patient with periodontal disease.Dental maintainance for patient with periodontal disease. Thomas GThomas G Wilson.Wilson.  Fundamentals of fixed prosthodontics - Shillingburg.Fundamentals of fixed prosthodontics - Shillingburg.  JPD, 1971; 25: 642 - 649.JPD, 1971; 25: 642 - 649.  JPD, 1981; 45: 268JPD, 1981; 45: 268 -- 277.277.  JPD, 1982; 48: 396 - 399.JPD, 1982; 48: 396 - 399.www.indiandentalacademy.comwww.indiandentalacademy.com
  79. 79. www.indiandentalacademy.comwww.indiandentalacademy.com

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