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Great Basin Academy Study Club

Great Basin Academy Study Club. March 2013. Roseman University of Health Sciences. Preparation of the Periodontium. Iatrogenic Causes and Restorative Considerations Supportive Periodontal Treatment (Maintenance ) Results of Periodontal Treatment. Presented by Craig M. Ririe, DDS, MS.

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Great Basin Academy Study Club

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  1. Great Basin Academy Study Club March 2013 Roseman University of Health Sciences

  2. Preparation of the Periodontium Iatrogenic Causes and Restorative Considerations Supportive Periodontal Treatment (Maintenance) Results of Periodontal Treatment Presented by Craig M. Ririe, DDS, MS

  3. Restorative Dentistry • Periodontium free of inflammation • Periodontium free of pockets • Periodontium free of Mucogingival involvement

  4. Implant Dentistry • Needs site development • Needs bone augmentation • Needs gingival augmentation

  5. Periodontal Disease must be eliminated prior to Restorative dentistry. • To determine gingival margins of restorations properly • Inflammation weakens abutment teeth stability • Teeth shift in presence of disease

  6. Elimination of Periodontal Disease • Resolution of inflammation in P.D.L. • Regeneration of P.D.L. fibers, APICAL to level of attachment loss • Can cause teeth to shift again

  7. Fixed bridge work designed for teeth BEFORE the periodontium is treated may produce INJURIOUIS tensions and pressures on the treated periodontium.

  8. Abutment teeth must have NO periodontal involvement – Before and after restoration is complete.

  9. Removable Partial Dentures Frame work should not be constructed until periodontal treatment is complete and healing is complete.

  10. A TRUE ADAGE GARBAGE IN GARBAGE OUT

  11. Tooth Mobility

  12. SUMMARY The goal of periodontal therapy should be to create the gingival mucosal environment and osseous topography necessary for the proper function of single tooth restorations and fixed and removable partial prosthesis.

  13. TREATMENT TO MAKE THIS HAPPEN Treatment Sequence: • Hopeless teeth are extracted • Construct TEMPORARY partial denture Construct TEMPORARY crowns with PROVISIONAL margins • PERIODONTAL THERAPY is performed. • 2 months after completion of periodontal therapy • Gingival health restored • Gingival sulcus mature • Periodontal membrane restored to health & function • Mobility decreased

  14. Treatment Sequence Continued 5. Preparations modified to relocate margins in proper relationship to the healthy gingival sulcus 6. Final restorations (fixed, removable, implants) are constructed

  15. Esthetic Needs Clinical crown of tooth must be adequate for retention of artificial crown.

  16. To get enough retention you may be tempted to place the margin into the junctional epithelium and connective tissue attachment.

  17. Result: Gingival inflammation Sometimes bone loss

  18. Biologic Width Violations Ramification of Biologic Width Violation margin placed within the zone of attachment

  19. Biologic Width

  20. Clinician has 3 options for crown margin placement: • Supragingival • Equigingival • Subgingival

  21. Biologic Width Concerns Equigingival margins

  22. Biologic Width Average Biologic Width Vacek, et. al.: can be up to 4.3 mm

  23. Evaluation of biologic width • Radiographs • Symptomatic • “Sounding”

  24. Probe to bone level and subtract sulcus depth (must be done on teeth with healthy gingival tissues)

  25. Treatment of Biologic Width Violation • Orthodontics • Surgery

  26. Biologic Width Violation Left central fractured and restored 12 months ago

  27. Biologic Width Violation Removal of bone would be unaesthetic

  28. Biologic Width Treatment Orthodontic solution erupted 3mm then surgery

  29. Biologic Width Violation Orthodontic/Surgical Before 1 year recall

  30. Surgical Crown Lengthening Before treatment

  31. “Golden Proportion”

  32. Surgical Crown Lengthening Ideal gingival symmetry

  33. Surgical Crown Lengthening Measurement taken for crown lengthening

  34. Surgical Crown Lengthening Incision following Ideal Symmetry

  35. Surgical Crown Lengthening • Final Restoration • Note the ideal symmetry

  36. Biologic Width • Average Biologic Width • Vacek, et. al.: can be up to 4.3 mm

  37. Margin Placement to Avoid Biologic Width Violation HISTOLOGIC SULCUS DEPTH ≠PROBING DEPTH

  38. Biologic Width • Average Biologic Width • Vacek, et. al.: can be up to 4.3 mm

  39. Iatrogenic Problems • Poor margin placement • Margins were covered when restored on Periodontally diseased tissue

  40. Electro Surgery • Tissue retraction for impression taking

  41. Temporary Crowns Critical Areas • Marginal Fit • Contour • Surface Finish

  42. Gingival Embrasure Loss of Papilla between #8, 9

  43. Gingival Embrasure Method for altering tooth form to fill embrasure

  44. Gingival Embrasure One year after restoring #8, 9 mesial

  45. Pontic Design • Sanitary Pontic • Ridge Lap Pontic • Modified Ridge Lap Pontic • Ovate Pontic

  46. Ovate Pontic Design Must be shallow

  47. Ovate Pontic in less esthetic area

  48. Ridge Consideration Ridge augmentation

  49. Iatrogenic Problems Maxillary Partial Denture

  50. Iatrogenic Problems Partial Denture Removed • Not removed and cleaned often enough • Not monitored by Dental Office often enough to check for plaque/allergic reaction

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