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INTRODUCTION
The periodontium is one of the most important anatomic structure of oral cavity in conjugation of fixed prosthodontics. Patient with dental prosthesis require periodontal maintenance at frequent interval because dental prosthesis is susceptible to accumulation of plaque and calculus,especially if margins are placed subgingivally or at the level of gingival margin. To maintain the healyh of periodontium is impoertant and so the various mechanical plaque control methods,which we use regularly,to maintain this state of health.
periodontitis, before prosthetic reconstruction is begun. However,prognosis of periodontal treatment is rendered questionable by prosthetic treatment that follow it. negative influence on periodontium
Prothetic construction
functional effect
phase
Funtional effects
The term functional effect refers to the influences cemented restorations may exert on periodontium or gingiva beneath the reconstruction
Funtional effect
Attached gingiva Recession
Subgingival margins
biotypes
Attached gingiva
Sufficient width is necessary for the restoration and
preservation of periodontal health If restorative treatment is planned, the goal of treatment is to eliminate periodontal inflammation and to preserve the attached gingiva through adequate plaque control Adequate width is one that has no negative impact on course and treatment of periodontal disease.
treatment
Denudation of bone to increase the width of attached
gingiva Clinical crown lengthening and augmentation Apically displaced partial thickness flap Connective tissue graft for augmentation of keratinised gingiva.
(1986): Attached gingiva should be robust and more stable If natural tooth is to be prepared and used as the part of tooth replacement,the risk must be minimised before placement.
:
temporary irritation caused by prosthetic treatment will lead to minor clinical problem and original shape will soon be restored
Gingival augmentation should be performed before crown placement Width around the teeth to be used as a abutment for crown with subgingival margin must be atleast 2-3 mm
placement
margin placement is associated with a high risk of gingival recession He observed 71% of subgingivally placed crown margins were located either supragingivally or at the level of gingival margin 10 years after placement of restoration. This underlines the difficulty in maintaining long term stability of gingival margin around teeth after subgingival crown margin placement.
Change in:
Probing depth
1.3mm
0.6mm
instrumentation of abutment with subgingival crown margin these instruments can damage the crown margins and even fracture the margin of ceramic crown. So at these sites,it may be necessary to limit to professional tooth cleaning to cleaning the tooth surface with gauze and cleaning the sulcus with carefully inserted dental floss.
Biotype
Extend of coronal migration is greater with thick
maintenance
Plaque control is difficult because tip of the brush
cannot be engaged efficiently. The side of the abutment facing the edentulous space is highly prone to accumulation of plaque, calculus and food.
have life expentancy of atleast a decade and with a high level of maintenance ,restorations are often seen surviving for 20-30 years. Patient must be educated and motivated to maintain a good oral hygiene. Method of plaque control should always be tailored to individual needs and ability. Suitable mirrors and plaque disclosing agents are also helpful.
Maintenance of prosthesis
Healthy
Compromised
Home care brushing flossing interproximal brushes Oral rinses Refer to specialist Non surgical treatment