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Cons lec. No.




Management of periodontally involved teeth :

*Success of any Restorative or prosthodontic treatment largely depends on long term healthy and stability of surrounding periodontal tissues .

If the pt have periodontitis u have to treat and wait then u have to evaluate , after that u can start your restorative work , the periodontal health must be in priority before initiation any work.

SO as a rule in your life , always make sure that periodontal status is healthy and stable before establishing restorative work .

*Periodontally compromised teeth : teeth that are surrounded by healthy periodontium , however reduced periodontium ( which means soft and hard tissues are less than normal ) usually have normal sulcus depth when probing between 1&2mm , have gingival recession but without any source or pathology .

-teeth concerned as abutment for RPD and FPD should have adequate attached gingiva , bone level ,sulcus depth not >3mm , mobility not more than Grade II and absence of any pathology .

If all these criteria present then this is healthy periodontal compromised teeth and can serve as abutment .

*Prerequisites of the restorative treatment :

1.Marginal location and integrity

Most favorable is supragingival , respective your biological width . you have to do probing if u have 1mm probing depth you can't do subgingival margin , but if u have 2-3mm u can do subgingival margin .

If u violate the biological width , u will end up with 2 scenarios :

A.gingival inflammation


Biological width :distance between crest of the bone and the base of the sulcus , its 2.04mm and consist of junctional epithelium and connective tissue .

So always do supragingival margin whenever possible , avoid damage to attachment apparatus and always make the margin well adapted ( not positive or negative ledge or open margin ) .

2.Tooth preparation :

If u make inadequate buccal preparation u will end with over contoured crown .

3.provisional Restoration :

Don’t be impinging ,well polished and the embrasure should allow adequate OH .

4.impression procedure :

That least traumatic , Retraction cord placement is the most traumatic during impression procedure

5.Crown contour :

Always do a flat emergence profile.

6.pontic and embrasure design :

1.ridge lap

2.modified ridge lap


4.sanitary (hygienic )

5.modified sanitary

*Treatment modalities fixed or Removable :

-Depends on :

1.abutment condition and number =>

-bone support

-root morphology & cr/root ratio


2.Ridge contour

3.occlusal forces

4.pt related factors => age , cost and demands .

*Biomechanical management :


Those teeth peridontally compromised so u have to expect that there is mobility .

Can result from :

1.reduced periodontal support … the resultant mobility is irreversible

2.increased periodontal ligament width (the mobility is reversible) ..

1.orthodontic trt

2.occlusal trauma

*if the tissues were healthy,the mobility called physiologic tooth mobility .

*in a tooth exposed to occlusal trauma there will be loss of bone level but without pocketing , however after relieving this occlusal trauma or selective grinding the level of the bone will return to normal level .

*Splinting : the only situation that we put 2 separate crowns as a one piece is to do splinting .

-we do splinting : 1.in grade II mobility

2.if a pt complain of tooth mobility

-Basic principles in splinting :

1.healthy periodontium

2.Multidirectional as much as possible

3.occlusal harmonized .. we try to distribute occlusal forces on a larges no. of teeth equivalently (equivalent simultaneous bilateral balanced occlusion so the occlusion will be stable and favorable) .

-its important to control direction , magnitude and the intensity of the functional forces .

-try to direct occlusal forces along the long axis of the tooth by achieving cusp to fossa points ( not cusp to margin or cusp to cusp points ) . Because lateral forces v.harmful to the teeth and forces along the long axis of the teeth will be dissipated alongperiodontal ligament in a harmonious healthy way .

-tooth mobility resulting from reduce periodontal support requires splinting only if masticatory function is disturbed .

*Types of splinting :

1.ligature wire .. not used anymore .

2.Acrylic Removable splint .. not v.comfortable to the pt and don’t do splinting all the time .

3.Direct composite resin .. between the teeth especially lower Ant. Teeth (Fixed) , in perio clinic when a pt come with reduced healthy periodontium in ant. Area we put composite and leave spaces to clean underneath . the problems here are the composite wear and it may breaks .

4.indirect composite .. we prepare the teeth then take an impression and the technician will prepare it .

-Metal veneers equivalent to direct composite in the past ,construct as a one metal piece we put it lingually .

5.cast metal splint

6.fiber reinforced composite .. mesh of polyethylene fibers or glass impregnated with composite .

Acid etch then bonding and apply the mesh .

7.Fixed Partial Denture … if we have a missing teeth and grade II mobility so we do a bridge to replace missing and do splinting.

*Splinting … in the final stages of periodontal diseases , the progressive breakdown of supporting tissues may reached an apical level , despite treatment and occlusal adjustment.

  • In a case report ; there were loss of periodontal tissues and when u see the radiograph definitely u will decide to extract the teeth , but here the dr. decide to put a bridge on the abutments and the bridge worked for 20 years .

  • Nowadays we don’t do FPD on mobile abutment because u have the implant choice , but if u have to choose between FPD and acrylic RPD .. the FPD will survive longer .

  • Conclusion from the case report : the functional forces exerted on the bridge are evenly distributed over the entire extension of the splint and their leathery effect is reduced especially when number and distribution is favorable ( Multidirectional or cross arch splinting ) .

  • Studies emphasize that success of treatment in these teeth u have to do adequate periodontal treatment , proper maintenance and stability of periodontal health and careful planning .

2. Furcation involvement :

You have many choices :

1.overlap treatment

2.tunneling procedure

3. root resection

4.amputation and hemisection

5.root separation

*prosthetic considerations for resected teeth :

1.the margin is thin chamfer or knife edge.

2.metal margin or gold

3. well adapted margin

4.minimal occlusion loading ( by evenly distributed forces )

5.make sure you have adequate biological width

6.make sure you have accessibility oral hygiene .

*Esthetic management :

-consequences of recession :

1.root caries


3.food impaction

4.phonetic concern

5.abrasion lesions

-management :

  • Perio treatment then treatment of recession .

  • If a pt have low lip line and the esthetic not in consideration you can treat the dentine hypersensitivity with any methods .

  • Acrylic Gingival prosthesis : difficult to accept it , but it solve many problems like esthetic , phonetics , give lip support and its removable and also it will reduce food impaction .

  • Colored ceramic could be a solution

Done by Sumaya H.Abuodeh

Forgive me for any mistake .

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