Romanian Journal of Oral Rehabilitation

Vol. 6, No. 2, April - June 2014

PROSTHETIC REQUIREMENTS IN PERIODONTAL PROPHYLAXIS

Kamel Earar1*, Mădălina Nicoleta Matei2, Sergiu Focşăneanu2, Constanţa Mocanu3
1
“Apollonia" University - Iași, Romania, Faculty of Dentistry
2
“Dunărea de Jos" University – Galaţi, Romania, Faculty of Dentistry

*Corresponding author: Kamel Earar, Assoc. Professor, PhD, DMD

“Apollonia" University
Iași, Romania

ABSTRACT
Aim of the study The purpose of this paper is to identify and analyze the shortcomings of achieving gnatho
prosthetic devices and their detrimental effect on periodontal health, and the periodontal protection methods
employed in the technological algorithm applied for fixed gnatho prosthetic devices. Material and methods To
achieve periodontal prophylaxis, we analyzed the compliance in clinical and technological process of a series of
technical requirements for rebuilding morpho- functional integrity of the dental arch by bridges. Results To
achieve periodontal prophylaxis should be pursued during clinical and technological procedures the following:
respect of coronary morphology, restoring the contour and position of contact areas, inter proximal embrasures
restoration, restoration of the physiological contours of the buccal and lingual surfaces, the correct reproduction
of natural cemento-enamel junction on mesial and distal faces, respect of gingival sulcus area, achieving perfect
adaptation of the margins of restorations, periodontal protection in sub-sulcular area, achieving the profile of
emergence. Conclusions By respecting these the principles, are ensured both restoration longevity and
periodontal health.

Keywords: key word one, key word two

INTRODUCTION gnatho prosthetic devices.

Prosthetic restorations are usually lost due
to periodontal damages or to the occurrence
of marginal caries, but, most of the times, due
to an incorrectly manufactured prosthetic
device. The long-term prognosis of a fixed
prosthesis depends to the greatest extent to
the connection it has with the marginal
periodontium.
AIM OF THE STUDY
The purpose of this paper is to identify and
analyze the shortcomings of achieving gnatho
prosthetic devices and their detrimental effect
on periodontal health, and the periodontal
protection methods employed in the
technological algorithm applied for fixed
MATERIAL AND METHODS
In order to achieve periodontal
prophylaxis, the clinical-technological
process observed a series of technological
requirements, which are summarized
hereunder:
• Observance of crown morphology,
• Reconstruction of the outline and position
of interproximal contact areas,
• Reconstruction of embrasures,
• Reconstruction of the physiological
outlines of the vestibular and oral crown
surfaces,
• Performance of an accurate enamel-
cement junction on the mesial and distal

64
 Romanian Journal of Oral Rehabilitation
Vol. 6, No. 2, April - June 2014
faces,
• Protection of the gum sulcus
• Achieving perfect adjustment of the
restoration borders
• Periodontal protection in the sub-sulcular
area
• Achieving the emergence profile.
The assessment of these principles was
done by analyzing the design and
manufacture deficiencies of 68 fixed gnatho
prosthetic devices, and by identifying their
negative effects on the marginal and deep
periodontium.
RESULTS AND DISCUSSIONS
Observance of Crown Morphology
Figure 1A, B. Location of interdental contact areas
Figure 2. Observance of West’s rules in the
restoration of the contact area in
periodontal prophylaxis
One of the periodontal prophylaxis
requirements is contact areas recovery in
order to prevent food impact. Food impact is
favored by the inaccurate choice of contact
area in connection to the vestibular and oral
surfaces. West’s rules should be observed
during the technological execution of the
65
When working on the outline of the axial
surfaces of the restorations, one must observe
the morphology of natural crowns [1]. Any
change in these parameters may have
detrimental effects on the integrity of both
marginal periodontium, and dental arches and
occlusion relations [2,3].
Reconstruction of the Outline and Position
of Interproximal Contact Areas
The interdental contact relations prevent
food impact, thus preventing both injuries and
interdental gum impairment [4]. Moreover, it
contributes to dental arch stability and
occlusion forces dispersion.
Figure 3. Outline of reconstructed
embrasures by micro-prosthesis modeling
contact area [5]:
 When the interdental space is smaller than
2 mm, a single-piece prosthesis is
recommended;
 When the space ranges between 2 and 4
mm, both teeth should be restored by fixed
prostheses;
 Romanian Journal of Oral Rehabilitation
Vol. 6, No. 2, April - June 2014
 When the space exceeds 4 mm, it should
be closed by the body of a fixed
prosthesis.
Reconstruction of Embrasures
Embrasures result from the curves of the
aproximal faces of the neighboring teeth,
being adjacent to the contact areas: vestibular,
oral, occlusal (incisal) and cervical (6). They
serve to guide food during mastication, thus
preventing vertical food impact. The size of
the embrasures depends on teeth shape and
size, which dictate the position of the
Figure 4. Thin periondontium
Figure 6. Changes in the connections
between crown surfaces and gum
Any type of periodontal biotype has a
particular ratio between the thickness of the
vestibular gum border and the convexity of
the cervical third of the teeth, which enhances
the continuity of the hard and soft tissue
profile, so that food is deflected above the
gum without getting into the gum sulcus.
Any alteration of the axial outline of the
crown surfaces reconstructed by prosthetic
66
interdental contact area. Embrasure
functionality is connected to the symmetry of
the morphological components (embrasures
symmetry law) [5].
Reconstruction of the Physiological
Outlines of the Vestibular and Oral Crown
Surfaces
Some particular morphological aspects of
the lining periodontium are connected to the
shape of the teeth. There are two major types
of periodontal morphology: thin-scalloped
and thick-flat [6,7].
Figure 5. Thick-flat periodontium
Figure 7. Excessive convexity in the cervical
area and its effect on the periodontium
means and the gum may result in destructive
changes.
Superoutlined restorations (excessive axial
curve) lead to gum inflammation and
hyperplasia, which accounts for the difficult
mechanical removal of dental plaque on the
surface under superoutlined convexities [8].
Extreme vestibular and oral surface
outlining should be avoided in order to
 Romanian Journal of Oral Rehabilitation
Vol. 6, No. 2, April - June 2014

achieve periodontal prophylaxis, as excessive Cement Junction

outlining seems to be more harmful than
infraoutlining [8].
Periodontal Prophylaxis when Defining
the Mesial and Distal Outline of the Enamel-
These outlines are particularly important
due to their connections with the epithelial
insert, as the later may be injured, especially
in the front teeth, during stump preparation
and cervical restoration adjustment [9,10].

Figure 8. Consequences of the failure to achieve the mesial and distal outline of the enamel-
cement junction in the maxillary canine

Figure 9. Retention areas resulting from inaccurate adjustment and insufficient polishing of a
fixed gnatho prosthetic device

Protection of the gum sulcus inaccurate marginal adjustment – the clinical

The borders of the restorations located in
the gum sulcus are thought to be an
etiological factor enhancing chronic
progressive marginal periodontitis [11].
Achieving perfect adjustment of the
restoration borders
When placing restorations borders in the
gum sulcus cannot be helped, the borders
should be impeccably fitted and finished, and
the intra-sulcular outlines should reflect gum
sulcus morphology [12].
The retention areas that are the result of
either insufficient finishing/polishing, or
detection of which is difficult – may lead to
bacterial plaque retention and to the turning
of that area in an ecologic niche [13,14].
Periodontal Protection in the Sub-sulcular
Area
The dental-gingival junction area
extending from the bottom of the gum sulcus
and the apex of the alveolar bone is described
as “biological space” (Gargiulo) [5]. When
the borders of a prosthetic restoration are
located in this space, the result is usually an
inflammatory response [15]. Therefore, the
most efficient way to prevent sub-sulcular

67
 Romanian Journal of Oral Rehabilitation
Vol. 6, No. 2, April - June 2014

area impairment is to pay special attention to to the interdental contact area.

protecting this area during stump preparation
and impression, as well as to avoiding
aggressive crown borders placing in the gum
sulcus [16].
Restorations with straight emergence
profile in the gingival third facilitate
toothbrush access.
Clinically speaking, the straightness of the
emergence profile may be checked on the
vestibular and oral surface of the restoration
by means of a periodontal probe. On the other
hand, the interproximal emergence profile of
the restoration and its marginal adjustment
are best assessed by X-ray [17].

Figure 10. Biological space violation. Papilla
compression and periodontal inflammation
occurrence due to inaccurate embrasure
conformation
Achieving the Emergence Profile
The emergence profile is the section of the
axial surface of the tooth which extends from
the foot of the gum sulcus, crosses the free
gum and enters the buccal environment. It
may extend vestibularly and orally to the
anatomic equator of the tooth [17].
Interproximally it extends from the foot of the
gum sulcus, from the enamel-cement junction
CONCLUSIONS
1. Extreme vestibular and oral surface
outlining should be avoided in order to
achieve periodontal prophylaxis.
2. On the one hand, intra-sulcular borders
favor periodontogeneous bacterial flora
development, and, on the other hand, they
prevent access for mechanical bacterial
plaque removal.
3. The borders should be impeccably fitted
and finished, and the intra-sulcular
outlines should reflect gingival sulcus
morphology.
4. The conformation of the interproximal
areas should allow access for plaque
control.

REFERENCES
1 Becker CM, Kaldahl WB. Current theories of crown contour, margin placement, and pontic design. J
Prosthet Dent. 2005;93(2) :107-15.
2 Broadbent JM, Williams KB, Thomson WM, Williams SM. Dental restorations: a risk factor for
periodontal attachment loss? J Clin Periodontol. 2006;33(11):803-10. 234
3 De Backer H, Van Mae1e G, De Moor N, Van den Berghe L. Survival of complete crowns and
periodontal health: 18-year retrospective study. lnt J Prosthodont. 2007;20:151-8.
4 Flemming I. Biological considerations and pretreatment procedures periodontal aspects. In: Karlsson
S, Nilner K, Dahl B., editors. A Textbook of Fixed Prosthodontics. Gothia: The Scândi¬navian
Approach. Forlagshuset; 2000. p.62-76.
5 Schillingburg HT, Hobo S, Whitsett LD, Jocobi R, Brackett SE. Fundamentals of fixed
prosthodontics. 3'd ed. Chicago (IL): Quintessence Publishing Co.; 1997.
6 Koke V, Sander C, Heinecke A, Muller HP. A possible influence of gingival dimensions on
attachment loss and gingival recession following placement of artificial crowns. Int J Periodontics
Restorative Dent. 2003;23:439-45.
7 Vasconcelos F. S. Q et all Influence of anatomic reference on the buccal contour of prosthetic crowns
Braz Oral Res 2009;23(3):230-5

68
 Romanian Journal of Oral Rehabilitation
Vol. 6, No. 2, April - June 2014

8 Kissov HK, Todorova BP, Popova EY. Correlation between overcontouring of fixed prosthetic
constructions and accumulation of dental plaque. Folia Med. 2001;43(1-2):80-3.
9 Goodacre CJ, Campagni WV, Aquilino SA. Tooth preparation for complete crowns: An art form
based on scientific principles. J Prosth Dent 2001; 85: 363-76.
10 Gunay H, Seeger A, Tschemitschek H, Geurtsen W. Placement of the preparation line and
periodontal health--a prospective 2-year clinical study. Int J Periodontics Restorative Dent. 2000;20:
171-81.
11 Kancyper SG, Koka S. The influence of intra crevicular crown margins on gingival health:
preliminary findings. J Prosthet Dent. 2001;85:461-5.
12 Padbury Jr A, Eber R, Wang HL. Interactions between the gingiva and the margin of restorations. J
Clin Periodontol. 2003;30(5):379-85.
13 Reitemeier B, Hansel K, Walter MH, Kastner C, Toutenburg H. Effect of posterior crown margin
placement on gingival health. J Prosthet Dent. 2002;87: 167 -72.
14 Kohal RJ, Pelz K, Strub JR. Effect of different crown contours on periodontal health în dogs.
Microbiological results. J Dent. 2004;32(2):153-9.
15 Giollo MD, Valle PM, Gomes SC, Rosing CK. A retrospective clinical, radiographic and
microbiological study of periodontal conditions of teeth with and without crowns. Braz Oral Res.
2007;21:348-54.
16 Schatzle M, Land NP, Anerud A, Boysen H, Burgin W, Loe H. The influence of margins of
restorations of the periodontal tissues over 26 years. J Clin Periodontol. 2001;28:57-64.
17 Nayyar A, Moskowitz M,. Pollard B L. Improving the Emergence Profile of Dental Restorations
with Accurate Reproduction of Soft Tissue Topography Journal of Esthetic and Restorative
DentistryVolume 7, Issue 1, pages 26–31, January 1995 Article first published online: 1 JUL 2007

69