Professional Documents
Culture Documents
ficient or questionable retention could be gained deeper the margins lie, the greater is the possibility
from supragingival margins. This was to give that it is unpolished (42).
greater length and surface area, and sometimes It is precisely these places which represent ideal
more parallelism, for increased retention. Today, bacteria colonizing areas at which, the moment it
the best way to achieve this is preprosthetic becomes too tight, result in localized inflammation
surgical crownlengh tening procedure, which and gingivitis. Oral hygiene maintenance in such
establishes an adequate biologic width and places is impossible, clinical signs being chronic
allows correct margin placement. inflammatory response and progress of attachment
Research in animals and humans (24,29-34) loss. These problems can be met halfway by proper
showed that marginal infection is most commonly casting techniques and polishing of the margins of
connected with subgingivally placed margins, and restorations. It is important to mention that every
that supragingival placement has a substantial pos- restoration whose margin lies supragingivally is less
itive effect on gingival health. Teeth with sub- potential to be ideal, compared to a restoration
gingival margins show higher inflammation index whose margin lies supragingivally.
values than sound teeth. There is a clear connection If the biologic width is violated, it is impossible
between plaque accumulation, caused by inadequate to maintain periodontal health. One or more of the
restorations, and periodontal disease (4). following develops (4):
1. Bone loss under the preparation margin that
Reasons for failure violated the biologic width. Pocket and pro-
A problem arises in cases where subgingival gressive periodontal tissue loss (periodontal
placement is absolute necessary. Different parts of ligament and bone) develop.
this complex (tooth, cementum and crown) can 2. Gingival recession and localized bone loss
easily become the location of plaque accumulation. develop. This happens in cases where the
There is a special stress on metal-ceramic crowns, labiobuccal bone is thin (43).
whose thin metal margin is usually oxidazed, air 3. Localized gingival hyperplasia with minimal
abraded, but can never be polished, and therefore is bone loss. Although this represents the best
rough. Opaque ceramic parts, which are coarse, also prognosis for the tooth, this course of action
become exposed. These factors play a great role in maximally compromises the esthetic component
plaque accumulation and periodontal health of a and is as such unacceptable for the patient.
patient (35-41). Hyperplasia is most frequently found in altered
passive eruption and subgingivally placed
Gingival inflammation, as well as periodontitis,
restoration margins.
can be, caused by improperly finished prosthetic
restorations. Such margins, whether they are pro- Patients with these findings always end up at a
duced directly or indirectly, are frequent, often periodontologist. After comprehensive examination,
everyday findings, especially if it is known that it case history and periodontal charting, the peri-
is almost impossible to ideally finish the margins of odontologist will start with an intensive oral hygiene
crowns and veneers (22). The most frequent reason programme, and, depending on re-evaluation
for incorrect margins is the impossibility to perform results, decide on surgical periodontal treatment.
proper casting and/or margin finishing when the Surgical procedures are described in the second
margin is already located subgingivally (26). The part.