Periodontal conditions in patients 5 years following insertion of fixed prostheses
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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.Keywords:
Gingival margin
ABSTRACT Periodontal disease affects nearly 50% of Americans but diagnostic methods have remained the same for decades. Periodontal examination via physical probing provides critical metrics such as pocket depth, clinical attachment level, and gingival recession; however, this practice is time consuming, variable, and often painful. In this study, we investigated high-frequency ultrasound (40 MHz) for the image-based measurement of periodontal metrics. Imaging was performed at midbuccal sites for a set of periodontally healthy (n = 10) and diseased (n = 6) subjects and image-based measurements were compared to gold-standard physical probing measurements. Human operators identified relevant markers (e.g., cementoenamel junction, gingival margin, alveolar bone crest) in B-mode ultrasound images from 66 teeth to calculate gingival height and alveolar bone level. These metrics were correlated to clinical measurements of probing pocket depth and clinical attachment level for disease staging (1.57-mm bias and 0.25-mm bias, respectively). Interoperator bias was negligible (<0.1 mm) for gingival height measurements and 0.45 mm for alveolar bone level measurements. The ultrasonographic measurements of gingival height and alveolar bone level served as effective diagnostic surrogates for clinical probing measurements while offering more detailed anatomical information and painless operation.
Cementoenamel junction
Gingival margin
Alveolar crest
Periodontal probe
Gingival recession
Bleeding on probing
Clinical attachment loss
Crest
Gold standard (test)
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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.
Gingival recession
Bleeding on probing
Gingival margin
Periodontal probe
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19 IMZ-implants with a medium age of incorporation of 10.5 months were examined at four sites concerning their periimplantary situation. Gingival index, bleeding on probing, pocket depth and composition of subgingival plaque corresponded in 67% of the examined sites with periodontal health. Favourable correlations were stated between the values of plaque index and of the bleeding on probing as well as between the wide of fixed gingiva and the dimension of gingival recession. Compared to bridge constructions more unfavourable results concerning the amount of plaque and clinical criteria of the gingival margin were observed in case of mucosal fixed prostheses.
Gingival margin
Gingival recession
Periodontium
Bleeding on probing
Periodontal probe
Bridge (graph theory)
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Crown lengthening surgery is a hot topic in clinic research.We often encountere too short teeth structures caused by caries or crown fracture.If the denture crown margin violate the biologic width periodontal problems will occur.Crown lengthening surgery,abide by the principle of biological width,using flap surgery combined with alveolar bone trimming can extend crown or expose the subgingival teeth structure by removing part of the alveolar bone and gum so as to reestablish healthy periodontal tissue in apical direction.
Crown lengthening
Gingival margin
Periodontal surgery
Margin (machine learning)
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T his investigation was undertaken to evaluate the long term clinical effect of free gingival grafts on the periodontal condition. Forty grafts, performed on 34 patients 1 to 8 years ago, were selected. Plaque and gingival indices were determined in the grafted areas. Direct clinical measurements from the cementoenamel junction to: a) margin of the gingiva, b) bottom of the gingival sulcus and c) mucogingival junction were also recorded. Similar examination of contralateral or adjacent 40 nongrafted areas for each patient was also conducted to serve as a control. Tissue mobility of the grafted and control areas was then recorded to the nearest 0.001 inch, using a specially developed device, which exerted a standardized tension of 50 gm perpendicular to the surface of the gingiva. Data was subjected to statistical evaluation to determine the significance of changes in variables between grafted and nongrafted sites. The following conclusions were drawn: 1) The zone of keratinized and attached gingiva, though more apically positioned, is significantly wider in the grafted sites. 2) There are no significant differences between grafted and nongrafted sites with regard to plaque index, gingival index and pocket depth. 3) In both grafted and nongrafted sites, a wider zone of attached gingiva corresponds to a shallower pocket depth. 4) There is a significant positive correlation between mobility of the graft and pocket depth. The present investigation, therefore, indicates that, while the free gingival graft is an effective means to widen the zone of the attached and keratinized gingiva, there is no indication that this increase bears direct influence upon periodontal health.
Gingival sulcus
Cementoenamel junction
Gingival margin
Periodontal probe
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To determine the capacity of ultrasonographic image-based measurements of gingival height and alveolar bone level for monitoring periodontal health and disease.Sixteen subjects were recruited from patients scheduled to receive dental care and classified as periodontally healthy (n = 10) or diseased (n = 6) according to clinical guidelines. A 40-MHz ultrasound system was used to measure gingival recession, gingival height, alveolar bone level, and gingival thickness from 66 teeth for comparison to probing measurements of pocket depth and clinical attachment level. Interexaminer variability and comparison between ultrasound measurements and probing measurements was performed via Bland-Altman analysis.Gingival recession and its risk in non-recessed patients could be determined via measurement of the supra- and subgingival cementoenamel junction relative to the gingival margin. Interexaminer bias for ultrasound image analysis was negligible (<0.10 mm) for imaged gingival height (iGH) and 0.45 mm for imaged alveolar bone level (iABL). Diseased subjects had significantly higher imaging measurements (iGH, iABL) and clinical measurements (probing pocket depth, clinical attachment level) than healthy subjects (p < 0.05). Subtraction of the average biologic width from iGH resulted in 83% agreement (≤1 mm difference) between iGH and probing pocket depth measurements.Ultrasonography has an equivalent diagnostic capacity as gold-standard physical probing for periodontal metrics while offering more detailed anatomical information.
Cementoenamel junction
Gingival margin
Periodontal probe
Gingival sulcus
Gingival recession
Clinical attachment loss
Bleeding on probing
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Gingival margin
Periodontal probe
Margin (machine learning)
Gingival sulcus
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Clinical crown lengthening is used as an adjunct to implant procedures, and can help provide a better long-term prognosis by establishing proper occlusal planes and aiding in preparation of the abutment teeth. Crown lengthening procedures may be especially useful when caries or a fracture extends below the gingival margin, compromising impression taking and marginal fit.
Abutment
Gingival margin
Impression
Margin (machine learning)
Crown lengthening
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Abstract The periodontal probe has been and continues to be used as an important diagnostic instrument by the dental profession. The measurements recorded with the probe have generally been considered to represent a reasonably accurate estimate of sulcus or pocket depth. Recent reports on the histopathology of the periodontal lesion and the histological features of a healing lesion, together with histological studies on the relationship of the probe to periodontal tissues, have shed some new light on periodontal probing. It is now apparent that probing depth measured from the gingival margin seldom corresponds to sulcus or pocket depth. The discrepancy is least in the absence of inflammatory changes and increases with increasing degrees of inflammation. In the presence of periodontitis the probe tip passes through the inflamed tissues to stop at the level of the most coronal intact dento‐gingival fibers, approximately 0.3–0.5 mm apical to the apical termination of the junctional epithelium. Decreased probing depth measurements following periodontal therapy may be due in part to decreased penetrability of the gingival tissues by the probe. Following treatment aimed at obtaining new attachment in periodontal defects, wider variations may occur between the location of the probe tip and the most coronal dento‐gingival fibers than in the case of untreated sites. This is due in part to the formation of a so‐called “long” junctional epithelium. In the absence of inflammation this epithelium may not be penetrable during ordinary probing, but could account for a rapid increase in probing depth measurements when inflammatory changes allow the probe to traverse the epithelium and/or the adjacent infiltrated connective tissue. In view of the difficulty inherent in relating periodontal probing measurements to actual sulcus or pocket depth, the interpretation of periodontal probing in the practice of periodontics may need reappraisal.
Gingival sulcus
Junctional epithelium
Gingival margin
Sulcus
Periodontal probe
Histopathology
Periodontium
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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.
Bleeding on probing
Gingival margin
Gingival recession
Clinical Significance
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