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The International Journal of Periodontics & Restcrofive Dentistry

75

Resin-lonomer and Hybrid-lonomer


Cements: Part II. Human Clinical and
Histologie Wound Healing Responses
in Specific Periodontal Lesions

Mick R. Dragoo ' Recently, modified resin-gioss-


ionomer formulotions were
placed OS subgingivai restora-
tive moteriols to restore teeth
that were previously considered
hopeiess and/or nonrestor-
obie.' Root iesions that require
subgingivoi restorations may
inoiude cases invoiving root
Twent/-ve subjects yyitti a totoi of 50 subgingivai restorations participated rsorption, fractured roots, ero-
in this study. At tt^e beginning ot ttie investigation, nine teeth that were con- sive lesions, endodontic perfora-
sidered iiopeless because of the extent cf tiieir pathaiogy were selected tions, and deep carious root
for extraction to evaluate histotogicoiiy the restarations and tiieir effect on lesions. Port i of this series
the adjacent tissues. The purpase of this orticie is to demanstrate the desoribed the ideoi charocter-
responses to the clinical appiicatians as yyeil as to the placement of resin- istics, occording to the author,
ionomers in subgingivai iesians. Clinical and histologie evidence ot epithe- of o subgingivai restorative
lial and cannective tissue adherence to resin-ioncmer restarative materiais material for the repair of such
was observed during the heaiing process. (Int J Periodont Rost Dent defects, as well as fhe differ-
1997:17:75-87,) ences between several restora-
tive materiais that ore poten-
tially suitable for this purpose. To
delineate and more corefuliy
define the wound heoiing
responses ot the periodontium
foilowing these subgingivoi
restorative procedures, clinical
and histologio evidence of
repair of fhe periodontal com-
"Visiting Professor, Universify of Nebraska, Lincoln, Nebrasi<a: and piex is necessary,^ Therefore,
Visiting Professar, Universify of Washington, Seattle, Wostiington, the purpose of this articie
Reprint requests: Dr Mick i. Dragoo. 1017 Quoil View Drive,
is to describe the ciinicai
Escondido, Calitornia 92026,

Volume 17, Number 1,1997


7

opplications and placement cf present (+) or absent (-) ((+) =


resin-ionomer restorative mate- 1, (-) = D). Gingivai recession
riais in subgingival iesions and was measured from the
to present the histoiogic wound cementoenamei junction (CEJ)
healing that follows these thera- and/or other fixed reference
peutic procedures. points that were available.
Change in attachment level
was determined from the
Method and materials chonges in probing depth, and
gingivai recession measure-
Twenty-five subjects in need of ments were taken at baseiine
a total of 50 restorations partici- and postoperatively Ail mea-
pated in this study All subjects surements were rounded off to
were intormed of their orai con- the nearest millimeter
dition, and all received a thor- Preoperative preparation
ough oroi and written explana- consisted of scaling and polish-
tion of the procedures to be ing, as well as instruction in the
pertormed. Atter a subject Bass method of tooth brushing,
received this information and the use of unwaxed dental tloss,
betre the procedure was and the Perio-aid (Butler). A
started, an informed consent period ot 4 weei<s was aiiowed
document was signed. Clinical for patients to develop skills in
documentation inciuded a piaque removai before the
complete-mouth periodontai exprimentai procedures com-
chart, radiographs. 35-mm menced. It should be noted
coior siides, assessment of gin- that although the subjects
gival inflammation based on achieved Plaque Index scores
the presence or absence of of one or beiow at the end ot
redness and bieeding on prob- this period, tew subjects main-
ing, ond the measurement ot a tained that level for the duration
Plaque index.'^' of the investigation.
Measurement ot probing Two resin-ionomer restorative
depth was made paraliel to materials, Dyract (restorative A,
the long axis of the tooth with a DeTrey/Dentsply) and Geristore
specialiy fabricated pressure- (restorative B, DenMat), and
sensitive probe caiibrated to 10 one hybrid-ionomer material,
g of torce. Aii probing measure- Photao-Fil (restorative C, ESPE
ments were rounded off to the Premier) were used to restore
nearest miilimeter. Bleeding on the dental iesions, Ali materiais
probing was assessed as either were used according to their
present (+) or absent (-) within manufacturer's instructions,
30 seconds after probing ((+) = Sinoe aii of the dental lesions
1, (-) = 0). Redness of the gin- in these investigations were
giva was assessed as either subgingivai, a fuii-thickness

The Internationdl Journoi ot Pertodonfics & Restorative Dentistry


77

mucoperiosteal flap was re- administered. The use of ontimi- Clinical case reports
tiected prior to restoration of the crobial mauth rinses was op-
lesion. To control the hemor- tionai otter the first week. Representative case reports
rhage from fhe periadontal liga- Subjects were recolied weekly from the 25 subjects ond 50
ment and alveolar bone, a 30% for the tirst 4 weeks, and then restorations evaluated for this
hydrogen peroxide solution on on a monthly basis for the first study are presented below.
o cotton pellet was applied to postoperative year, and every 3
the surgical site for 5 seconds to months thereafter tor an assess-
achieve hemostasis. An alterna- ment of periodontal condition. External raot rsorption
tive method would have been Prior to performing the
to use the Stabident System restorative procedures, a total Externol resorptive lesions were
(Fairfax Dentai) with a local of nine teeth that had been ciassified by Mesaros and
onesthetic containing a vaso- diagnosed as hopeiess by the Wayman^ according to the fol-
constrictor. This technique was patients' dentists were seiected lowing etioiogy: perlapical
designed to allow local anes- for extraction to undergo histo- inflammation, reimplontatian oi
thetic to be injected directly logie evaluation. AM of the teeth, tumors and oysts, trauma,
into the alveolar process vyith patients selected for the histo- impootion of teeth, and idio-
resuiting vasoconstriction and logie part of fhese studies were pathic conditions. The following
onesthesia. Once the restora- immediate denture patients two cases are descriptive of the
tions were in place, they were who were referred by their gen- physioiogic resorptive process
finished with a fine-grit diamond eral dentists. Ot the nine teeth, that tokes ploce as a result ot
inflammatory rsorption.^ These
only, and no attempt was made three teeth were seieoted for
cases may be charaoterized by
to polish the restored surtaoe. treatment with each product.
intense inflammation with areas
When the subgingival lesion At the end of 3 months, these
of bovyl-shaped rsorption of
had invaded the puip oanal, restored teeth with adjacent
the cementum and dentin.
the pulp was extirpated ond o tissues were removed vyith the
gutta peroha point was placed ridge-preserving technique
into the root canals to maintain previously described to histoio-
the patency of the canal prior gioally evaluate restoration-
to the placement of the re- tooth-tissue interfaces.2 The
storative materiai. The root biopsies were fixed in 7D% alco-
canal fillings were completed hol and embedded in methyi
subsequent to the subgingival methacrylate for microscopio
restoration. examination. Serial sections
The mucoperiosteal flaps were out at 10 to 15 pm, and
were replaced and sutured every tenth section was stained
with a 4-0 silk suture, A perio- with either hematoxyiin and
dontal dressing (Coe-Pack, GC eosin, toludine biue, or mineral-
America) vyas piaced for the ized bone stain (MIBS), All
tirst postoperative week. No stained sections were studied
ontibiotics were prescribed or under the light microscope.

Volume 17, Number 1,1997


78

Fig la (ieft) Clinical photograph


depiofing the exfent of the destruction
of the roat and crown, r/ie root was
destroyed approximately 2 mm apical
ta the alveaiar crest.

Fig Ib(ieft) Clinioaiphotograph af


fhe root and crown restored wift^ a
resin-ionamer restarafive material. The
restarafive materiai was piaced
approximately 2 mm subcresfal. and a
new bone-resforation space had fo be
created with a thin, fine-grif diamand.

Fig fc(tignt) Radiogioph faken 1.5


yeors pastaperative.

Fig d Clinical phatagraph taken 1.5 years postoperative. Note the lack of gingiv
inflammation adjooent fa the resin-ionomer material and triat the dihicai crown
and roof were restored with the resin-ionamer material oniy. The toath as been i
funcfion wifhout a past-and-care buiid-up and a crown lesforation.

Case I jected to expose the resarptive used to create a restoration-


lesioh in the root surfoce. A bone space and finish the mar-
A 31-year-old man presented round carbide bur v/as used to gin cf the restoration. The flap
vi/ith a root resorptive lesion on estabiish a solid tooth surface to was replaced. At 1,5 years post-
the lingual surface of his canine. receive the restoration (Fig la). operative, the tissue appeared
Radiographic evidence and A gutta-percha point was ciinicaily healthy and well
surgical exposure revealed that piaced in the root canal to adapted to the root surface
the iesion extended approxi- keep the canal accessible for (Figs I c and Id). No redness
mateiy 2,0 mm apicai to the the projected endodontic pro- and/or bleeding on probing
alveolar crest. An endcdantic cedure. The restorative material was present. Probing assessment
access opening was made vi/as piaced approximately 2 demonstrated minimai sulous
in the croyi/n, and the puip mm subcrestai ta inciude the depth, which suggested tissue
vyas extirpated, A fuii-fhickness entire resorptive lesion (Fig Ib). attachment fo fhe resforation.
mucoperiosteai tlap was re- A thin, fine-grit diamond was

The Ihterhational Journai of Periodontics & Restorative Dentistry


79

Case 2 Fig 2Q Clinical photograph depicting


mot rsorption destruction of the facial
root surface. Note the gutta-percha
A 41-year-old woman pre- point In the root canal to maintain
sented with a root resorptive canal patency. The root canoi wos
compieted subsequent to sealing of
lesion on the iabial surface of the root surface wifh the resin-ionomer
her anterior tooth, A flap was restorative material.
reflected, and a lingual access
opening was made in the
crown to extirpate the pulp. A
Fig 2b Ciinicol photograph iliustrating
gutta-percha point was placed the resin-ionamer restoration In the root
in the root canal to preserve resorptive iesian. The restoration wos fih-
and maintain patency of the ished with a fihe-grit diamond bur

root canal tor endodontic ther-


apy (Fig 2a). The resin-ionomer
restorative material was then
piaced to restore the lesion in
the root (Fig 2b). The restoration
was finished with a fine-grit dia- Fig 2c Clinioai photograph of the tis-
mond, and the fiap was sue flap sutured over the resin-ionomer.
sutured coronai to the aiveoiar Note the distance between the CEJ
and ftie coronoi edge of the flap.
crest (Fig 2c). At the end of 1
year a noticeabie iack of gingi-
val infiammation and minimal
sulcus depth were apparent
adjacent to the resin-ionomer
materiai (Fig 2d),
Fig 2d Clinicai photograph taken I
year postoperative. Note the shaiiow
suiculor depth. taci< of gingivai infiam-
mation, and change in flap position
over the resin-ionomer restoration when
compared to Fig 2c.

Voiume 17, Number 1,1997


fig 3a Clinical photogroph depicting Fig 3b Ciinicai photograph lilusrrofing fig 3c Fignteen-month postoperative
massive destruction of oiveoiar bone the apex (retrofil) and laPiai split root photograph depicting a shaiiow gingi-
ond a spat root (orrow). restored with a lesin-ionomer material. val sulcus adjacent to the restored roof
The surtoce of the restorative moterioi surface.
was anished with a fine-grit diamond bur.

Root fracture extensive pocket formation Restoration af caries under


mesiofacioiiy. Radiographie evi- existing crawns
Acute or chronic trauma may dence indicated that the tooth
result in verficai crown and root had been endodonticaliy Cories may occur at or apical
fractures. The defect moy be a treated. Upon reflection of fhe to the morgin of a single crown
partiol or complete fracture fissue, it wos noted thot the and/or bridge abutment.
involving the crown and/or iobial root was fractured verti- Usuoily the treatment of choice
root." Froctures have frequently cally (Fig 3a), The fractured is to remove the orown ond/or
been associated with extensive area ond the opical foramen of bridge, restore the cories (possi-
dentai treatment. The following the root conal were restored bly preform a periodonfal surgi-
case describes a verticol frac- with o resin-ionomer materioi cal crown iengthening proce-
ture repoir. (Fig 3b), Eighteen months post- dure) and replace the crown
operative a shallow gingivoi sui- and/or bridge. The aforemen-
cus adjacent to the restored tioned can be o costly dental
Case 3 root surface was noted, and the option for the patient. Advance-
labial fistuia was no longer pre- ment in odhesive dentistry and
A 52-year-old womon pre- sent (Fig 3c). The tissue was not studies on the biocompatibility
sented for periodontal treot- inflamed, oithough piaque of resin-ionomer moteriols con
ment on a mandibular canine could be observed ot the gingi- now offer the patient a more
with a deep pocket and iabioi val morgin. cost-effective aiternative.
fisfula, Ciiniooi probing reveoled

The Infernotional Journai of Periodontics & Restorative Dentistry


81

Case 4

A 48-year-oid man presented


with deep caries under a crown,
a furcation invoivement, and a
necrotic pulp on a right man-
dibuiar right first moiar. The
moiar was the distal abutment
for a three-unit bridge. The
Fig4a Ciinicai phofogtaph of a Fig 4b Three-yeor posfopetotive ciini-
patient couid not atford to have mondibular righf firsf molar bridge olDuf- coi photograph iiiustrofing fhe favor-
the bridge replaced, but did menf depicting roof cones ond o furca- abie response of fhe crown and gingi-
fion invoivemenf. vai compiex fo fhe resin-ionomer
consent to having endodontic resforofion wifh no signs of breakdown.
treotment and a resin-ionomer
restoration placed to restore the
carious iesion. Since certain
resin-ionomer cements bond to
both gold and dentin, this treat-
ment concept seemed iike a
reasonabie alternative. Subse-
quent to endodontic therapy, a
tull-thici<ness flap was reflected
to expose the e>rfent of the cari-
ous lesion (Fig 4a). The caries
was removed, and a resin- Root perforafion denture by his gnerai dentist.
ionomer restoration was piaced The endodontic prooedure wos
on the root and under the Unfortunately, iatrogenio injuries completed prior to tissue reflec-
crown. The tiap was replaced to such as root perforotions during tion. A resin-ionomer restoration
its former position and sutured. endodontic procedures and/or wos pioced on the labiol sur-
Figure 4b demonstrates that the preparation for post-ond-core face of the tooth to repoir the
gingival complex ond the exist- buiid-up may occur in ciinicai iesion, finished with a tine-grit
ing bridge has respanded favor- proctice even with diiigent diamond, and the tissue was
ably for 3 years with no signs of care. The toiiowing case sutured into piace. Three months
recurrent caries, periodontai depicts a simuiated root perfo- later, during the placement ot
infiammation, or separation of ration that was repaired with a the immediate denture, the
the restoration from the goid resin-ionomer restoration. labial aspect of the tooth and
crown. adjacent tissue was taken tor
histoiogic assessment. Histoio-
gicaliy it was apparent that the
Case 5
tissue was adherent to the resin-
Histologie case reports ionomer used to repair the root
Atter flap retiection, a root perfo-
perforation (Figs 5a and 5b).
[Representative case reports ration was simulated on the
trom the nine histoiogic tissue iabiai surtace of a central incisor
specimens evaluated far this of a 55-year-old man, who was
study are presented beiow. scheduied tor an immediate

Volume 17. Number 1,1997


82

teeth, the flap was positioned


coronaiiy to cover the entire
restored root surface. Three
months postoperative, the
probing depths were shaliow,
and gingival inflammation (ie,
redness and/or bleeding on
probing) was not evident even
in the presence of bacterioi
Fig 5a Ciinicai photograph of a cen-
frai incisar wifh a simulated roat lesion
piaque (Fig 6b), The labiai
thaf cauld have been created by an aspects ot the teeth and adja-
endadontic post peroration, acciden- cent tissues were removed for
tal endodantic perforation, or a refrotii
endodonfic procedure. The perforation histoiogic evaluation of the lat-
was restared wifh a resin-ionamer mafe- eral incisor and first premoiar
rial to evoluafe fhe wound healing.
prior ta the extractions and
piocement at an immediate
maxillary denture by her gen-
Fig 5b Micrograph snowing fne iibrob- eral dentist. The histoiogic sec-
lasts and connective fissue (CT) nexf fo tions of the lateral incisor and
the resin-ianomer restoration (Rl) in first premalar exhibited a mean
dentin (D) and the absence of inflom-
mafory cells. soft tissue coverage over the
resin-ionomer restoration of
7.02 mm, which consisted of a
mean sulcus depfh of 1.07 mm,
a mean epitheliai attachment
ot 1.82 mm, and a mean con-
nective tissue adhesion of 4.13
mm. The histoiogic sections
revealed bacteriai plaque
Facial raaf restoration Case adjacent to the gingivai sulcus
and a iack of inflammatory
Recent advances in restorative A 46-year-oid woman who was oelis adjacent to the piaque
dentistry have ailowed facial scheduled for the piacement and suicus (Fig c). This iack of
lesions to be estheticaliy of a maxillary denture by her infiommatary ceils couid also
restored, i-iowever. concerns general dentist presented with be observed in high-power
have been raised when saft tis- supragingival and subgingival micrographs of the junotional
sue coverage is also desired. root caries and sett tissue de- epithelium a d j a c e n t to the
The following case describes hiscences on the labiai surfaces resin-ionomer material (Fig d).
the placement of a resin- of a iaferai incisor and first pre- i-ligher-pawer micrographs illus-
ionomer restoration in such a moiar.The canine was missing. A trate the close adhesion of the
iesian and the subsequent flap was reflected so the teeth fibroblosts and connective tis-
placement of tissue aver the could be adequately restored sue to the resin-ionamer restora-
restorative material. with a resin-ionomer restoration tion (Fig e).
(Fig a). After restoring the

The Internotionol Journai of Periadontics & Restorative Dentistry


83

fig 6a Clinioal pnofograph of a lafer- Fig Ob Ciinicai phofograph of fig o 3 Fig 6c i\/iicrograph of a tissue biock of
ai incisor ahd first premoior. Nate fhe monfhs posfoperotive depicting soft the the laterai ihcisar in Fig 6a takeh 3
ioblai root surfaces are restated with a tissue coverage aver the resin-ianamer months postoperative. Note baoteriot
resin-ianamer material (arrows). material piaced on the faciai root plaque (F) on fhe resin-ionomer
iesions. Note fhe presehce ofbocfena! resfaration (RI) in the denfin (D) next fo
piaQue hear the matginai gingiva. fhe shallow gingival sulcus (S), and the
relative lock of ihftommotofy ceiis ih the
gingival tissues adjacent ta the plaaue
and sutous. (Original magnificatian x
50)

Fig 6d (left) High-power micrograph


depicting the uhctionai epithelium {Jt)
adjacent to the resin-ionomer restoro-
fion (Ri), Note the tack of infiommatary
celts. (Origihai magnifioafioh x 250).

Fig 6e (right) Higher-power micro-


.::raph depictihg fibrabiasfs (F) oncf
cohnective fissue (CT) adjaceht ta fhe
resin-ionamer restarafioh (R\). (Ofiginai
magnificafion x 500.)

Volume 17,Number 1, 1997


Clinical discussion Certain resin-ionomer restor-
ative materiais possess proper-
The subgingivai lesions restored ties that are biocompatible
in this study were traditionally with periodontai tissues. This bio-
considered to be unrepairable compatibility may be related to
by many dentists. Based on the the antimicrobial activity of the
tindings of this sfudy, subgingi- fluoride release of resin-ionomer
vai restorations may now be materials that affects the com-
placed in a more routine fash- position of the bacterial plaque
ion, because the materials and piaque biochemistry by
tested exhibited dentin bond- altering carbohydrate metabo-
ing capabilities and biocom- lism (see Fig 6o),^ All of the
patibiiity to surrounding tissues. cases demonstrated minimal
Resuits indicate that, except signs of clinicai infiammation
for the nine predetermined (redness and/or bleeding on
teeth that were extracted and probing. Tables 2 and 3) in the
the four restorative A tiiiings that heaiing areas, even in the pres-
debonded, ali af the teeth ence of plaque, it was interest-
restored subgingivqily continue ing to note that olthough the
to be in tunotion after periods piaque score increased over
ot 1 to 3 years. Although the the postoperative course (Table
patients were required to 1), gingival infiammation de-
obtain a Piaque index of 1 or creased (Tables 2 and 3).
below to begin the study, the Postoperative gingival re-
mean PI exoeeded this ievel cession was minimai tor ali
subsequent to the restorative procedures. At 1 year postoper-
prooedures (Table 1), All of the ative, the mean gingival reces-
restorqtive materials exhibited sion was 0.42 mm, Aiso at 1 year
fluoride release, which may postoperative there were signiti-
have altered the nature af cant decreases in probing
plaque surrounding fhe restora- depths and gain in attachment
tions. Gingival inflammation, as with ali three materials tested
assessed by redness and/or (Tables 4 and 5), Aithough
bieeding on probing, was mini- restorqtive A had 0.51 mm more
mai after healing (Tabies 2 and probing depth than material B
3). Probing depths are iisted in and 0.59 mm more probing
Table 4. The mean gains in depth than material C, there
attachment ievei after 1 year were no significant differences
are indicated in Table 5, in the gain of sott tissue attach-
ment values vt/ith any of the
materiais tested. Further study
will repori on the ditterences in
biocompatibiiity to bone tissue.

The International Journal of Periodontics & Restorative Dentistry


85

it was aiso interesting to Table 1 Plaque Index (mean SD)


note the positive correlation
Restorotive
between redness and bieeding A B C
on probing at 1 yeor postoper-
Preoperative 0,86 0.35 0.68 0.47 0,80 0.40
otive (Tabies 2 and 3). When 3 mo 1.29 0.59 1.09 0,51 1,60 0,49
the soft tissue was advanced mo 1.54 0.63 1.05 0,51 1,57 0,49
coronoily over restored subgin- ly 1.30 + 0.61 I.100.46 1,29 0.70
givai lesions (ie, coronaliy posi-
tioned flaps to cover exposed
root surfaces), the clinicai prob- Table 2 Gingival inflammation (mean SD)
ing depths were minimai and
the gingival tissues appeared Restorative
A C
to adhere to the repaired root
PreoperativG 0.92 + 0,26 0.77 0.42 0.90 0,30
surfaces (Table ), Preoperative 3 mo 0.29 + 0.45 0,09 0,29 0,10 0.30
ond postoperative probing 6 mo O.ld + 0.35 0,05 0.22 0.14 0.35
depths were similar: however, 1y 0.080.27 0.050.22 0.140.35
the postoperative gain in ciini-
coi attachment wos 4.25 0.43
him over preoperative volues. Table 3 Bleeding on probing (mean + SD)
The postoperative chonge in
marginai gingiva (ooronol od- Restorative
A C
vanoement) was 4.00 0.71
Preoperotive 0.92 0.26 0.82 0.39 0.90 0,30
mm,
3 mo 0.36 0,48 0,39 0.47 0,40 0.49
Certoin restorative moteri- mo 0.23 0.42 0.05 0.22 0.M0.35
ois hove the ability to reduce 1 y 0.08 0.27 0.05 0.22 0.14 0.35
ond/or eiiminate the incidence
of microleakoge. The resin-
ionomer restorotive moterioi Table 4 Probing depth (mean + SD)
may act as a seal to minimize
any internal or external bacter- Restorative
A C
ioi contaminaticn between the
Preoperative 6.14 0.83 5,55 0.75 5.10 0.70
restorative margin on the tooth 3 mo 3.07 0.46 2.45 0.66 2.20 0.40
ond the surrounding tissues, mo 3.15 0.53 2.58 0,67 2.71 0,45
thereby facilitating the heaith 1 y 3.30 0.61 2.79 0 83 2.71 0.88
of the gingival complex.
Crown lengthening was not
performed in any of the ooses Table 5 Mean attachment
where the lesion extended to level gains after 1 year
or below the crest of the bone.
Restorotive
The teeth were restored to full A B U
functionolity whiie maintoining
Mean 2.14 2.27 2.20
on esthetic result. 0.74 0.79 0.75
SD
SD = Sfandord aevicifion.

Volume 17, Number 1,1 W7


Table 6 Clinical measurements for soft tissue Histologie discussion
coverage over resin-ionomers

Mean SD Histoiogic findings suggest epi-


Preoperative probing depth 2.5 0.50
theiium and connective tissue
Postoperative criange in marginal 4.0 0.71 odherence to the resin-ionomer
gingiva (coronal ottacriment) restorative materials during the
3-month postoperative 2.25 0.43 wound healing process. Cases
probing dGpth
Attachment level gain 4.25 0.43 presented in this report indicate
that it may be possible to re-
SD = Standard deviation
store the junctionai epithelium
and connective tissue adhesion
to resin-ionomer restorations
Table 7 Histoiogic measurements of soft tissue and deter crown lengthening
coverage over resin-ionomer ot 3 months procedures that may resuit in
postoperotive (mm) adverse esthetics and/or more
complicated orai hygiene pro-
Mean
cedures. With crown iengthen-
Sulcus depth 1.07
Length ot epittieiiai at attaohment
ing procedures it is usually nec-
1.82
Connective tissue adhesion 4.13 essary to expose sufficient tooth
by the removal of bone to
ailow the restoration to be
placed without impingement
on the bioiogic widfh.*-^ Table 7
shows the mean values ot serial
sections taken trom histoiogic
biopsy specimens.
it is interesting to note the
oomparison of the ciinicai mea-
surements (Table 6) and histoio-
gic meosurements (Table 7). The
combined histoiogic measure-
ments of sulcus depth and epi-
thelial attochment are 2.89 mm,
and the clinicai probing depth
was 2.25 mm. The histoiogic con-
nective adhesion was 4,13 mm
compared to the 4.25 mm clini-
cal attachment gain. Additionai
histoiogic studies are warranted
to confirm the new attachment
and/or adhesion between the
resin-ionomer restorative materi-
ais and the periodontai tissues
noted in this study.

The interndlional Journoi ot Periodontics & Restorotive Dentistry


87

Conclusians References

1, The author suggests that 1. Scherer W, Dragoo M. New subgin-


gival restorative procedures with
resin-ionomers need to pos- Geristore resin ionomer. Pract
sess the following physical Periodont Aesthet 1995;(Jan/Feb):
characteristics to be used os 1-4.
an ideal subgingival restora- 2. Dragoo MR. Regeneration of the
tive material; biooompati- Periodontal Attachment in Humans.
New York, NY: Lea & Febiger 1981:
bility, dual-cure set, odhe- 7-18.
siveness, fluoride releose, 3. Mesaros AJ Jr, Woyman BE.
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Acknowledgments
The author would iike to sincereiy convey
his oppreciation to Timothy Stoli, DDS for
his heip in the clinical evaluations, ond to
Kent Zimmerman, MD (clinicai, anatomic,
and cytopothologist) for his expertise in
interpreting the histoiogic material. Ali the
ciinicoi ond histoiogic research present-
ed in this paper was prlvateiy funded by
Dr Mick R. Dragoo; however, the restora-
tive materials were donated by manu-
facturer representatives.

Volume 17,Number 1,1997

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