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Interrelationship between periodontics-Restorative Dentistry.pptx
- 1. PERIODONTICS-RESTORATIVE DENTISTRY Prepared by: RedeatZeryhun Abebe ClinicalYear II DDS Student
- 2. OUTLINE • Introduction • Applicationof periodontics in Restorative Dentistry • Application of Restorative Dentistry in periodontics • Periodontal Considerations In Restorative Dentistry • Periodontal maintenance in the Restorative patient
- 3. INTRODUCTION • Periodontal healthand the restoration of teeth share an intimate and inseparable interrelationship. • For restorations to survive, long-term restorative procedures must be performed on a periodontium free of inflammation and pockets without any mucogingival involvement, and with the contour and shape of the periodontium corrected for a good functional and esthetic restorative result.
- 4. APPLICATION OF PERIODONTICSIN RESTORATIVE DENTISTRY 1. Pre-restorative periodontal care 2. Periodontal surgery for the placement of restoration
- 5. 1. PRE-RESTORATIVE PERIODONTAL CARE •Active periodontal disease must be treated and controlled prior to any restorative procedure. • Margins of restorations covered by inflamed gingiva shrinks after periodontal treatment.
- 6. 2. PERIODONTAL SURGERYFOR THE PLACEMENT OF RESTORATION • Free gingival graft and full crown restoration:When the attached gingiva is totally absent and the soft tissue crown interface has been compromised by recession or inflammation Periodontal plastic surgery (free gingival graft) should be carried out atleast 2 months before placement of dental restorations. • Crown lengthening procedures: done in cases of subgingival caries, fracture and when there as inadequate clinical crown length for retention.A full thickness flap extending to adjacent teeth and osseous reduction to gain sound tooth structure are required.
- 7. APPLICATION OF RESTORATIVE DENTISTRYIN PERIODONTICS 1. Excavation of Dental Caries and Restoration • Caries destroy tooth structure, creating open contacts, poor embrasure form and plunger cusps all of which encourage food impaction, plaque retention and periodontal disease. • Restoration of dental caries should be conservative with normal interproximal contacts and proper embrasure space preventing plaque accumulation and creating environment conducive to periodontal health.
- 8. CONT.… 2. Restorative Correctionof Open Gingival Embrasures • Open Gingival embrasure is caused Due to: • Bone loss; thus the papilla becomes inadequate • interproximal contact is located too high coronally: • Can be corrected by moving the contact point to the tip of the papilla; margins of direct bonded restoration is carried subgingivally 1 to 1.5 mm, and the emergence profile of the restoration is designed to move the contact point towards the papilla while blending the contour into the tooth below the tissue
- 9. CONT.…. 3. Management ofGingival Embrasure form with Periodontal Recession • In esthetic areas, it is necessary to carry the interproximal contacts apically toward the papilla to eliminate the presence of large open embrasures. • With multiple unit restorations, it is possible to bake porcelain papillae directly on the restoration using tissue-colored ceramics.
- 10. CONT.. 4. Restoration ofRoot-resectedTeeth • The removal of a root alters the direction of occlusal forces on the remaining resected teeth. • A cast post and core may be indicated to create an adequate foundation for the final restoration • The one-piece cast post and core restoration is placed. Heavy convexities should be avoided for restoring these teeth for hygiene access. • Gingival embrasure created must me accessed with an interdental brush.
- 11. CONT.. 5. Splitting • Splintingstabilize mobile teeth during periodontal surgery and also during the healing period following surgery. • Various restorative materials can be used for intracoronal and extracoronal splinting such as amalgam, acryclic or composite.
- 12. PERIODONTAL CONSIDERATIONS IN RESTORATIVEDENTISTRY 1. Margins of restorations 2. Gingival management for making impressions 3. Contour of restoration 4. Occlusal surface 5. Surface finish of restorative materials 6. Restoration of hemisected and resected tooth 7. Restorative procedures 8. Materials 9. Restorative design features for periodontally treated teeth
- 13. CONT.. 1. Margin • Thelocation of the gingival margin of restoration is directly related to the periodontal health status • A clinician has three options for margin placement: I. Supragingival II. Equigingival (even with the tissue) III. Subgingival • Supragingival margins have the least impact on the periodontium. Subgingivally located margins are associated with large amounts of plaque, more severe gingivitis and deeper pockets.
- 14. RULES FOR MARGINPLACEMENT • Rule 1: If the probing depth is 1.5 mm or less, the restoration margin has to be placed below gingival tissue crest. • Rule 2: If the probing depth is more than 1.5 mm, then the margin of the restoration is placed at one half of the probing depth below the gingival crest. • Rule 3: If the sulcus probing depth is more than 2 mm, then the tooth has to be evaluated for gingivectomy procedure to reduce the sulcus depth to 1.5 mm. Once this is achieved margin placement is done in accordance to Rule 1.
- 15. RESTORATIVE MARGINS ENCROACHING ONTHE BIOLOGIC WIDTH • The soft tissue attachment to the tooth between the base of the gingival sulcus and the crest of the alveolar bone is called the Biologic width. • Biologic width = Junctional epithelium (0.97 mm) + Connective tissue attachment (1.07 mm) = 2.04 mm.
- 16. METHODS TO CORRECTBIOLOGICAL WIDTH VIOLATION • Biological width violation can be corrected either: • Surgically (removing bone away from proximity to the restorative margin) or • Orthodontically (by moving the tooth and thus moving the margin away from the bone): 1. By slow orthodontic extrusive force 2. By rapid orthodontic extrusive force
- 17. CONT.. 2. Gingival managementfor making impressions • For subgingival preparation margin extending to the appropriate depth in the sulcus, gingival tissue must be protected from abrasion. • Tissue management is achieved: 1. gingival retraction cords of the appropriate size 2. Electrosurgery
- 18. CONT.. 3. Contours • Overcontouredcrowns and restorations tend to accumulate plaque and prevent self -cleansing mechanism of adjacent cheek, lips and tongue.
- 19. CONT.. 4. Occlusal Surface •Restorations that do not conform to the occlusal patterns of the mouth cause occlusal disharmonies that may be injurious to the supporting periodontal tissues. 5. Surface finish • The surface of restoration should be smooth so as to limit plaque accumulation. Rough restorative surface in subgingival region result in plaque accumulation. • Thus all restorative materials placed in gingival environment must have the highest possible polish.
- 20. CONT.. 6. Restoration ofhemisected and resected tooth • Mandibular Molars: both parts of hemisected tooth are to be retained, it is essential that an adequate embrasure space must be created between the two halves of the tooth, as it is too narrow. • When a mandibular molar is hemisected and one portion is extracted, the remaining portion serves as an abutments for a three unit bridge. • Maxillary Molars: When a mesiobuccal or distobuccal root has been resected, it is necessary to hollow out the crown contours in the area coronal to the area where root was resected so that adequate access is available for oral hygiene procedures. • When palatal root has been resected, the crown is made thinner buccopalatally, with a groove running in the midpalatal surface resembling a mandibular molar
- 21. CONT.. 7. Restorative procedures •Injudicious tooth separation injure the supporting tissues of the periodontium. • The use of rubber dam clamps, copper bands, matrix bands and discs may lacerate the gingiva resulting in gingival inflammation. • Excessive vigorous condensing of gold foil restorations may also be the source of injury to the periodontium.
- 22. CONT.. 8. Materials • Inflammatorygingival responses related to the use of alloys containing nickel in dental restorations have been reported. • Glass ceramics and porcelain veneers offer a clear advantage over any other type of restorative material in the maintenance of gingival health. 9. Restorative design features for periodontally treated teeth • Restoration of badly broken down, periodontally involved teeth or periodontally treated teeth pose a challenge to clinician. • When replacing all the occlusal surfaces the width of occlusal table should be reduced to minimize the amount of forces to be received by the periodontally involved tooth.
- 23. PERIODONTAL MAINTENANCE INTHE RESTORATIVE PATIENT Restored tooth • Non abrasive dentifrice is indicated to prevent the possibility of abrasion of acrylic. • Fluoride containing dentifrice is important for the protection of remaining tooth surfaces, particularly exposed cementum. • Acidulated fluoride preparations are contraindicated for porcelain and composite restorations.
- 24. CONT.. Root-resected restored teeth •Interproximal areas of root-amputated and hemisected teeth often present with surface concavities on the root trunk, and these areas cannot be adequately cleaned with floss. • Gingival embrasure form created in the restoration must be fluted into these areas so that the surfaces can be accessed with an interdental brush.
- 25. SUMMARY • Restorations, whenimproperly constructed, can become etiologic factor for the periodontal disease. • Proper contact, contour, occlusion, marginal adaptation and surface finish are as important to periodontics as they are to restorative dentistry.
- 26. REFERENCE 1. Periodontics JaypeeBrothers, 1st edition 2. Essentials of Clinical Periodontology and Periodontics, 3rd edition