Perio-Prostho Interface Flashcards
How does the implant interact with the periodontium?
JE contacts titanium
No PDL
No proprioception
Osseointegration
Gentle probing force
Collagen fibres arrange in a collar around the implant (perio disease can progress rapidly)
Name the 9 periodontal visal assessment categories?
Gingival inflammation
Recession
Crowding
Drifting
Plaque and calculus levels
Restorations/prostheses
Suppuration
Occlusal interference/trauma
Periodontal phenotype
What is the definition of healthy perioodntal tissue?
Pale pink gingivae
Papillae filling ID space
No root surface exposure
change in colour at mucogingival junction - pink and red
Clinical symptoms of gingivitis?
Oedema
Redness
Loss of stippling
Plaque/calculus
Plaque retentive factors
Clinical symptoms of unstable periodontitis?
Redness
Oedema
Loss of stippling
Gingival recession
Black triangles
Drifting/tilting of teeth
Plaque/calculus
Plaque retentive factors
Inflammation may be masked in smokers
What are the aestehtic considerations to think of during visual assessment?
Smile line
Recession
Crowding/spacing
Gingival contour
Periodontal phenotype
What is the definition of the periodontal phenotype?
Gingival thickness: probe transparency
Keratinised tissue width: measured vertically with probe (from gingival margin to mucogingival junction)
Health considerations:
in thin phenotypes there is higher risk of recession (restorative or surgical procedures)
In thick phenotypes pocket formation more likely
Aesthetic considerations: shine through of metal substructures
Where should the bone level be radiographically for normal levels?
Where should the alveolar bone be?
On average, up to 2mm below the CEJ (accounts for supra-crestal tissue attachment), Stage I if clinical attachment loss is more than 2mm from CEJ
Periodntal stability should be stabilised prior to any resorative intervention - why?
Can maintain good OH
Gingival margin position stable (aesthetics, ensure not encroaching on biologic width)
Procedural difficulty reduced (moisture control, accuracy of impression (elastomeric impression material is hydrophobic, needs dry surface), better fit of extra-coronal restoration)
What are the adv and dis of supragingival margins?
Benefits:
- Low risk of encroaching on biologic width
- Can visually inspect restoration margin
- Easy to identify and remove cement
- Cleansable
Disadvantages:
- Aesthetics (may not be appropriate in aesthetic zone, discuss with patient)
What are the adv and dis of equigingival margins?
Previously thought to favour plaque accumulation, however not the case
Improved aesthetics
Accessible to remove cement and polish
What are the adv and dis of subgingival margins?
Not desired option (may be unavoidable due to caries/deficiencies/high smile line/restorations)
If margins are too subgingival they encroach on biologic width,
cause gingival inflammation (may result in subgingival margin becoming supragingival)
Plaque accumulation (difficult to clean), recession, pocket formation
Ideally, do not exceed 0.5mm subgingivally
Biologic width can be violated even by simply carrying out subgingival preparation (iatrogenic damage can occur, gingivae can be traumatised when using retraction cord prior to impression taking)
Can lead to compromised impression and fit
Describe impression taking for restorative margins?
Subgingival margin impression taking for indirect restoration can require gingival retraction
Do not use excessive force (can cause recession)
Retraction cord (removal can cause bleeding)
Retraction cord with astringent (impregnated with vasoconstrictor)
Expasyl (less traumatic, paste administered with a fine tip, viscous and ridged, displaces gingivae, less traumatic
How should the restoation contour be produced? and the possible consequences?
Should be flush with natural tooth
Overhangs/deficiencies can cause plaque stagnation areas and local irritation, lead to bone loss
Risk of overhang increases in subgingival margins
For indirect restorations, papilla management can be carried out with effective selection and use of a wedge
How should the interproximal contact points be produced and possible consequences?
- Should not impinge on interproximal papillae
- Optimum interproximal contact point should prevent food packing and allow interdental cleaning
- Should be 2-3mm coronal to soft tissue attachment
- 5mm rule: when distance between contact point and bone crest is 5mm or less, papillae will fill embrasures (if more than 5mm=black triangle)
What if there is already gingival recession and loss of interdental papillae?
‘black triangle’ - challenging to correct as widening the tooth may increase the bulbosity making it more difficult to clean, may result in further recession
- diagnostic wax-up should be considered
- Trial with labmade temporary crowns
