Restorations for patients with periodontal disease

Question 1

Why is periodontal stability important in restorative

Answer 1

o Gingiva will bleed during operative procedures which can be detrimental + it can be unstable
o It is unstable in apico-coronal location
o Makes effective restorative dentistry impossible

Question 2

What is supracrestal attachment

Answer 2

o Supracrestal attached tissues are histologically composed of the junctional epithelium and supracrestal connective tissue attachment (around 3mm)
o When you place restorations subgingival, you can only really get away with 0.5mm subgingival and even then, 80% end up with recession

Question 3

What will happen if you encroach >0.5mm on supracrestal attachment

Answer 3

o Persistent inflammation
o Loss of attachment - pocketing,
recession

Question 4

What are keys to periodontally succesful indirect restorations

Answer 4

o Start with healthy tissue
o Adequate tooth preparation
o Precise margin location
o Excellent provisional restorations
o Careful tissue handling and impression technique