gingiva and its restorative considerations

7/25/2019 Gingiva and Its Restorative Considerations

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INTRODUCTION

NORMAL GINGIVAIRRITATING FACTORSMARGINS PLACEMENTSGINGIVAL RETRACTION (DEF)

INDICATIONS&CONTRAINDICATIONSPRINCIPLES OF RETRACTIONPHYSICAL MEANSCHEMICAL MEANS

NONCORD RETRACTIONROTARY CURRETAGEELECTRO SURGURYGINGIVAL SULCUS

ENLARGEMENTREFERCENCES


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Improper management of the periodontal tissues

during restorative procedures is common, but

often overlooked cause of failure. When a

restoration is placed, the preservation of an intact,

healthyperiodontium is necessary to maintain the

tooth or teeth being restored. Predictable long-term

restorative success requires acombination of

restorative principles with the correct management

of the periodontal tissues.


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NORMAL GINGIVA PART OF THE ORAL MUCOSA

THAT COVERS THE ALVEOLAR PROCESS OF THE

JAW AND SURROUNDS THE NECK OF THE TEETH.

MARGINAL GINGIVA TERMINAL EDGE OR BORDER

OF THE GINGIVA SURROUNDING TEETH LIKE A

COLLAR. DEMARCATED FROM ADJACENT

ATTACHED GINGIVA BY THE FREE GINGIVALGROOVE. IT IS ABOUT 1 MM WIDE. IT FORMS THE

SOFT TISSUE WALL OF THE GINGIVAL SULCUS.

GINGIVAL SULCUS SHALLOW CREVICE AROUND

THE TOOTH, BOUNDED BY SURFACE OF TOOTH ON

ONE SIDE AND EPITHELIUM LINING THE FREE

MARGIN OF GINGIVA ON THE OTHER. IT IS V-

SHAPED. 2-3MM.


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ATTACHED GINGIVA FIRM, RESILIENT, TIGHTLY BOUND TO

THE UNDERLYING PERIOSTEUM OF ALVEOLAR BONE. FACIAL

ASPECT ETENDS TO RELATIVELY LOOSE AND MOVABLE

ALVEOLAR MUCOSA FROM WHICH IT IS DEMARCATED BY THE

MUCOGINGIVAL JUNCTION.

WIDTH MAILLA MANDIBLE

ANTERIOR 3.! - ".! MM 3.3 - 3.# MM

POSTERIOR 1.# MM 1.$ MM


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are not feasible, restorative margins should be placed at

least 3 mm from the alveolar crest. This dimension allows a

distance of 1 mm for each part of the gingival attachment

(connective tissue attachment and epithelial attachment), for

a total of 2 mm. The additional 1 mm is for a healthy gingival

sulcus.


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INTERDENTAL GINGIVA OCCUPIES THE GINGIVAL

EMBRASSURE WHICH IS THE INTERPROIMAL SPACE

BENEATH THE AREA OF TOOTH CONTACT. IT HAS APYRAMIDAL OR &COL' SHAPE.


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Chronic gingival inflammation around

anterior crowns.


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ROUGHENING OF THE ENAMEL OR DENTIN

()*+

*/0*0

ENHANCES S4 055 06*77*0.

REACTION OF THE PERIODONTIUM

MARGINAL GINIVITIS TO PERIODONTITIS.

MORE SEVERE PERIDONTAL REACTION WITH CARIOGENIC

LOSS OF PHYSIOLOGIC CONTACT 8 CONTOUR OF THE TOOTH.


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SEPERATION OF TEETH SHOULD NOT ECEED THE WIDTH

OF THE PERIDONTAL LIGAMENT SPACE 9%.2 %.! MM:.

IF SEPERATION DOES ECEED THIS, THE PDL WILL BE

COMPRESSED ON ONE SIDE OF THE TOOTH AND TORN ON

THE OTHER SIDE.

FURTHER TRAUMA LEADS TO IREVERSIBLE ISCHAEMIA.


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INTERSEPTAL RUBBER

COMPRESSION ISCHAEMIA OF THE INTERDENTAL GINGIVA

AND FACIAL AND LINGUAL PAPILLAE.

CLAMPS INCORRECTLY CHOSEN OR APPLIED

TRAUMATI;E THE GINGIVA.

DENTAL FLOSS OR TAPE USED TO SEAT INTERDENTAL

RUBBER

LACERATION OR STRANGULATION OF ENTRAPPED GINGIVA.


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VIBRATIONS CAN LEAD TO LACERATION, COMPRESSION,

ISCHAEMIA OF PDL FIBERS, DILACERATION OR CESATION OF

ROOT FORMATION.

BEFORE PREPARING THE PROIMAL PORTION OF ANY

TOOTH, PLACEMENT OF WEDGES APICAL TO CONTACT AREA

WILL ASSURE PROTECTION OF UNDERLYING PERIODONTIUM

FROM THE MECHANICAL AND PHYSICAL TRAUMA OF

INSTRUMENTATION.


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hould be !rm

"nyielding #

$iologically

active

hould properly

%ontour bu&li #Me&di dimension

'or proper

%ontact #

contour

roper contour

c&gi so does not

*+tend apically

roper

tabiliation

$y wedges

To avoid

-aceration # contu&

ion f slipped

apically


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PHYSICAL RETRACTION METHODS

oFORCED PAST THE APICAL ETENT OF THE GINGIVAL CREVICE

oSTRANGULATION OF GINGIVAL TISSUE.

SURFACE LAYER TISSUE COAGULANTS

LEAVE GINGIVA IN STATE OF INFLAMMATION

oWITH SURFACE ULCERATION

oPARTIAL LOSS OF SULCULAR EPITHELIUM.

FLUID COAGULANTS LEAVE GINGIVA IN INFLAMMED STATE.

ELECTROSURGERY LEAVES TISSUES COVERED WITH A COAGULUM

ACCOMPANIED BY MINUTE ULCERATIONS.


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/*0T 'M /%-- -

04 *5T/*M% -M*60$-*

M*4 M0T*0-.

Mechanical trauma caused

$y repeated insertion

0nd removal of impression

Trays and material.

%atalysts #

%hemical

byproducts of

rubber

$ase elastomeric

mpression

Materials

%ause allergic

reactions.


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RESIDUAL MONOMER.

EOTHERMIC HEAT OF POLYMERI;ATION.

IRRITATING


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hape should beMaintained to

e8ect food0way from

gingiva

rovideMasticatorye9ciency

irect'unctional

'orces along-ong a+is of

tooth

rotectThe

eriodon&tium

revent Tilting#

upra&eruption


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CONTACT TOO BROAD BU-LI 8 OC-GI CHANGES ANATOMY

OF INTERDENTAL COL, INCREASING SURFACE AREA OF

IRRITATION PRONE , NON-KERATINI;ED GINGIVA.CONTACT TOO NARROW, WILL ALLOW ADVERSE VERTICAL

STRESSES AND INVITE FOOD IMPACTION.

CONTACT TOO OCCLUSAL RESULTS IN FLATTENED MR AT

EPENSE OF OCCLUSAL EMBRASSURE.

CONTACT TOO GINGIVAL DIMINISHES GINGIVAL

EMBRASSURE AND EAGGERATES OCCLUSAL EMBRASSURE.

SURFACE FINISH OF RESTORATION IS RELATED TO ITS

CAPACITY TO RETAIN PLA


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GINGIVA TENDS TO RECEDE AS PATIENT MATURES.

SO IN YOUNGER AGE GROUPS, MARGINS SHOULD

BE PLACED IN GREATER PROIMITY TO THE

GINGIVA.

SUB GINGIVAL MARGINS ARE EFFICIENT IN

PROVIDING A MASKING EFFECT OF THERESTORATION PLACED.

HOWEVER OTHER FACTORS MAY ALSO BE

CONSIDERED.


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TOOTH SURFACE FORMING THE WALL OF THE

GINGIVAL CREVICE IS AN AREA RELATIVELYIMMUNE FROM DECAY.

THEREFORE, PLACING A MARGIN SUBGINGIVALLY

COULD IMPART SOME PROTECTION FROM

RECURRENT DECAY IN PATIENTS WITH HIGH

CARIES RATE.


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MORE EFFICIENT PATIENT CONTROLS PLA


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AMALGAM

SUPRAGINGIVAL MARGINS.

SUB GINGIVAL MARGINS INDICATED INCASE OF

HIGH CARIES RATE.

DIRECT TOOTH COLORED REDTORATIONS

MARGINS SHOULD BE PLACED SUPRA GINGIVALLY

AS NONE OF THESE ARE COMPATIBLE WITH THE

PERIODONTIUM.


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CAST RESTORATIONS 8 PORCELAIN RESTORATION

SUBGINGIVAL MARGINS.

NOTE :

IN ANY CASE THE APICAL EXTENT OF THE DECAY IS THE

PRIMARY DECIDING FACTOR IN WHERE TO PLACE THE MARGIN OFTHE RESTORATION.


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OF

cords


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cords

eady made cotton or synthetic woven.

available in di>erent sies.

may be supplied impregnated with chemical

or chemical may be added before or after

insertion in sulcus.

advantage ?non adhesive to the tissues

disadvantage ?di9culty in inserting

into sulcus.

drawn cotton rolls


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soft loose cotton rolls which are readily

rolled into re@uired diameter.

they are then inserted into the sulcus which

is already impregnated or to be impregnated

with chemical.

advantage ?A easily introduced into the

sulcus than cords becauseof its looseness.

A more e9cient than cord ascan incorporate more ofchemical.

disadvantage ?part of coagulated sealingarea on sulcus wall may bepeeled o> initiatingbleeding # 8uid seepage.

cotton pellets
http://images.google.co.in/imgres?imgurl=http://www.mutualindustries.com/beauty/assets/images/cottonrolls.jpg&imgrefurl=http://www.mutualindustries.com/beauty/html/cotton_rolls___wipes.html&h=158&w=225&sz=7&tbnid=kGuzh_yt6SEJ:&tbnh=71&tbnw=102&hl=en&start=13&prev=/images%3Fq%3Dcotton%2Brolls%26svnum%3D10%26hl%3Den%26lr%3Dhttp://images.google.co.in/imgres?imgurl=http://www.mutualindustries.com/beauty/assets/images/cottonrolls.jpg&imgrefurl=http://www.mutualindustries.com/beauty/html/cotton_rolls___wipes.html&h=158&w=225&sz=7&tbnid=kGuzh_yt6SEJ:&tbnh=71&tbnw=102&hl=en&start=13&prev=/images%3Fq%3Dcotton%2Brolls%26svnum%3D10%26hl%3Den%26lr%3Dhttp://images.google.co.in/imgres?imgurl=http://www.mutualindustries.com/beauty/assets/images/cottonrolls.jpg&imgrefurl=http://www.mutualindustries.com/beauty/html/cotton_rolls___wipes.html&h=158&w=225&sz=7&tbnid=kGuzh_yt6SEJ:&tbnh=71&tbnw=102&hl=en&start=13&prev=/images%3Fq%3Dcotton%2Brolls%26svnum%3D10%26hl%3Den%26lr%3D


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cotton pellets

used to carry chemical to the already

compacted inserted cord or drawn cotton rolls.

custom temporary restoration

use of bulBy temporary cements liBe inc

o+ide eugenol or non eugenol periodontal

pacB.

can be used in combination with cotton roll.

taBes about 2&3 days.

heavy weight rubber dam


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heavy weight rubber dam

used when multiple teeth isolation is needed.

it has an immediate e>ect.


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$and is marBed on buccal side.

%rimping and adGustments done.

mpression material poured.


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SOLUTION FOR GINGIVAL RETRACTION

/*MT0T% -"T4 ;/%/ %ontains


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536 in!% (789!m) '%" bott*%:

Pascord Twisted cord with Aluminum Sulfate


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gingiva and its restorative considerations

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