Periodontal conditions and carious lesions following the insertion of fixed prostheses: a 10-year follow-up study.
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Summary The oral hygiene, gingival condition, pocket depth and loss of attachment were studied during a period of 5 years in a group of patients (114) who had been treated with fixed dental protheses. Eighty‐four per cent of the subjects had received periodontal therapy prior to the prosthetic treatment. During the study the subjects participated in an oral hygiene programme. Crown margins were located sub‐gingivally, at the gingiva, and supra‐gingivally. Initially 65% of the crown margins were sub‐gingival compared to 41% 5 years later. When the crown margins were located sub‐gingivally there was an increase in Gingival Index scores 2 and 3, in pocket depth, and in loss of attachment compared to a supra‐gingival placement. However, most of the alterations were small.
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THE PURPOSE OF the present study was to evaluate, using controlled probing forces, the response of periodontal pockets to a single episode of root planing. The clinical characteristics of 128 pockets (3-7 mm depth) distributed in ten subjects, were monitored immediately before and 1, 2, 3, and 4 weeks after a single episode of subgingival root planing. The clinical parameters measured were: pocket depth and bleeding after probing with 15 gm, 25 gm, 50 gm of controlled probing force and manual probing, gingival margin location, loss of attachment, gingival and plaque indices. Oral hygiene instruction and supragingival prophylaxis were given at each time point. An average aggregated score for each subject for each parameter was calculated at each time point. A repeated measure all-within analysis of variance was done, and the Tukey multiple range test was used to assess the significance of differences among and between the means. Plaque and gingival indices decreased significantly after 1 week. Significant pocket depth reduction (initial) occurred 1 week after root planing, and reduced further (secondary) at 3 weeks. Initial pocket reduction was associated with significant gingival recession, whereas secondary pocket reduction was associated with significant gain of clinical attachment. Bleeding upon probing was virtually absent after 3 weeks. All probing changes were detected more consistently using controlled insertion pressures. It was concluded that substantial reduction in pocket depth occurs within 3 weeks after a single episode of root planing owing to initial gingival recession and secondary gain in clinical attachment.
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The aim of the present study was to determine the influence of gingival dimensions on the development of gingival recession following placement of artificial crowns. The study population consisted of 11 periodontally healthy patients in whom 44 maxillary anterior teeth and/or premolars had to be crowned. A total of 36 teeth (82%) had, after crown placement, a mean intracrevicular crown margin of 0.57 +/- 0.47 mm. Thirty-nine teeth without restorations served as controls. Immediately after incorporation, as well as after 3, 6, 9, and 12 months, periodontal examinations were carried out. Gingival thickness was determined sonometrically and averaged 1.25 +/- 0.40 mm. Mean periodontal probing depth was 1.80 +/- 0.54 mm. Twelve months later, crowned teeth had experienced a mean attachment loss of 0.17 +/- 0.99 mm as compared to an attachment gain of 0.18 +/- 0.46 mm at control teeth. At test teeth, the gingival margin had receded a mean of 0.43 +/- 0.74 mm. In multivariate analyses considering the correlated structure of the data employing generalized estimating equation methods, crown placement was identified as a major factor for attachment loss and development of gingival recession. In addition, a shallow probing depth and narrow band of gingiva negatively influenced the level of periodontal attachment. The present results point to the importance of a more detailed periodontal diagnosis of the dentogingival region before placement of artificial crowns.
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Abstract The purpose of this investigation was to study whether or not artificial crown margins at the gingival margin are compatible with periodontal health. Periodontal conditions and the composition of subgingival plaque of 47 crowned teeth, 22 with crown margins at the gingival margin and 25 with a supragingival location of the margin, in 5 patients with extensive fixed bridgework has been examined 1 year after prosthetic treatment. Patients had been treated for periodontal disease and were recalled for prophylaxis sessions once every 2nd or 3rd month. Clinical data indicated little inflammation of the gingival tissues of crowned teeth with margins at the gingiva while at teeth with a supragingival location of the crown margin, gingival tissues showed minor or even no clinical signs of inflammation. In general, the composition of the subgingival plaque was similar to a flora regularly found to be associated with healthy conditions.
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Achieving a harmonious marginal gingiva is an important factor in esthetic dentistry. However, surgical crown lengthening of single teeth risks asymmetry of the gingival outline in the esthetic zone. In restorative dentistry, excessive gingival retraction or deep subgingival preparation can cause facial gingival recession. This case report describes a novel approach for facial crown lengthening of single teeth using intentional gingival retraction and provisional direct restoration.After administration of anesthesia, facial bone sounding was performed. Gingival retraction cords were pressed into the connective tissue attachment from the mesial to the distal line angle. A provisional direct restoration was then performed. These procedures were repeated until an ideal gingival outline was achieved.Intentional gingival retraction with provisional direct restoration appears to be useful for facial crown lengthening of single teeth in periodontal biotypes with thin bone.
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Abstract The position of the gingival margin of the incisor and canine teeth, indicated by clinical crown height, was measured using a standardised photographic technique, in 30 dental students over a 3‐year period. There was a progressive increase in mean clinical crown height during this period, suggesting that continual passive eruption of the teeth was occurring. There was a significant slowing in the rate of change over the period 1975–1977 for tooth 33, the reason for which is unknown.
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Background: Previous surgical crown lengthening studies have investigated positional changes of the free gingival margin but not the biological width. Histological studies utilizing animal models have shown that postoperative crestal resorption allowed reestablishment of the biological width. However, very little work has been done in humans. Therefore, the purpose of this study was to evaluate the positional changes of the periodontal tissues, particularly the biological width, following surgical crown lengthening in human subjects. Methods: Twenty‐three (23) patients who needed surgical crown lengthening to gain retention necessary for prosthetic treatment and/or to access caries, tooth fracture, or previous prosthetic margins entered the study. The following parameters were obtained from line angles of treated teeth (teeth requiring surgical crown lengthening) and adjacent teeth with adjacent and non‐adjacent sites: plaque and gingival indexes, free gingival margin, probing depth, attachment level, bone level, direct bone level, and biological width. During surgery, the bone level was reduced based on the future prosthetic margin and predetermined biological width; flaps were placed at the bony crest. Patients were examined at baseline and at 3 and 6 months postoperatively. Results: Eighteen patients completed the study. Overall, the amount of bone resected was 1 to 5 mm. At 90% of treated sites, ≥3 mm of bone was removed. At 3 months, the apical displacement of the free gingival margin at non‐adjacent, adjacent, and treated sites was 2.46 ± 0.25 mm, 2.68 ± 0.20 mm, and 3.07 ± 0.16 mm, respectively. There was no significant change in the position of the free gingival margin from 3 to 6 months. The biological width at all sites was smaller at 3 and 6 months compared to baseline ( P <0.05) except for the treated sites, which were not significantly different from baseline at 6 months. Conclusions: During surgical crown lengthening, the bone level was lowered for placement of the prosthetic margin and reestablishment of the biological width. The biological width, at treated sites, was reestablished to its original vertical dimension by 6 months. In addition, a consistent 3 mm gain of coronal tooth structure was observed at the 3‐ and 6‐month examinations. J Periodontol 2003;74:468‐474.
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T he present study evaluated the clinical stability of healed periodontal pockets over a 3 month time period to determine whether this time interval is appropriate for periodontal maintenance therapy. The clinical characteristics of 128 pockets (3–7 mm depth) distributed in 10 patients, were monitored immediately before and 4, 8 and 16 weeks after a single episode of subgingival root planing. The clinical parameters measured were: pocket depth and bleeding after probing with 15, 25 and 50 gm and manual probing, gingival margin location, clinical attachment level, and gingival and plaque indices. Oral hygiene instruction and supragingival cleaning were given at each time point. An average aggregated score for each subject and for each parameter was calculated at each time point. A repeated measure all within analysis of variance was done, and the Tukey multiple range test was used to assess the significance of differences among and between the means. The significant decreases in plaque, gingival and bleeding indices, and pocket depth as well as the significant gingival recession and gain of clinical attachment which were present at the 4 week point were maintained at 8 and 16 weeks after root planing. It was concluded that the favorable clinical changes which occur in periodontal pockets within 1 month after a single episode of subgingival root planing combined with improved oral hygiene can be maintained for an additional 3 month time period.
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