PERIODONTAL APPROACH TO ORAL REHABILITATION

PERIODONTAL APPROACH TO ORAL REHABILITATION

          Periodontal approach to oral rehabilitation should deal not only with any  periodontal disease that may be present but above all the question of restorative Rx and prosthesis is damaging periodontion.

          Periodontal approach is oral surgical procedures from periodontal point of view, following precautions need to be taken while raising uncoperiosteal flaps in order to maintain good periodontal status post surgically.

          Avoid trauma to exposed root surfaces 2 present loss of attachment, avoid pulling flaps up 2 crown margin to prevent formation of pseudopocket, use smaller flaps and follows less bone exposure slight spical positioning of reuse bend flap is better than conventional circular mucogingival flap procedures. Avoid scratching of 2^nd molars and distal pocket formation.

          Use of GBR and bone replacement materials helps in preventing the alveolar ridge resorption following extractions surgical techniques using PTFE and graft placement helps prevents soft tissues ingrowth in healing extraction sites and preserves keratinized mucousa and gingival architecture.

Perio/Endo/Cons:

          For restoration to survive long term and have good prognosis, its better necessary that periodontum be maintained in healthy state, for which restorations need to be critically managed in several areas so that they are in harmony with surrounding periodontal tissues margin placement. supragingival margins are preferred biological width. Periodontal point of view, biological width assessment need to be performed for patients undergoing restorative therapy to maintain gingival tissues in healthy conditions. Biological width violates due to ill effects of subgingival restoration and this requires immediate attention for prognosis of restored tooth.

Approaches to Presence Biological Width:

          Surgical removing of bone away from proximity to restoration and orthodontic extraction.

Subgingival Margin à Access limited / difficult cleaning, polishing

         

Periodontim  ß     Biological Width ß Plaque accumulation

Gingival recession / bone loss à pour prognosis

Margin placement guidelines and perio status

Rule	Sulens depth	Restorative margin	Biological width relation
1	Probing depth =less 1.5mm	0.5mm below gingival crest	Prevents biological width violation
2	Probing depth > 1.5mm	1 ½ depth of sulans below crest	Preventws recess
3	Sulans depth > 2mm	Gingivecloncy (crown lengthening)	Rx by rule 1

Provisional Restoration:

Marginal Fit	Crown Contour
Open Margin	Inadequate 2th preparation
Plaque Accumulation	ncrocontoured restoration
Gingival inflammation	Gingival inflammation

The processed silicone gingival prosthesis:       

          Clinical use of flexible removable gingival prosthesis that is constructed by dental lab on stone cast to reproduce inter dental spaces resulting from gingival recess is described this replaces lost gingival tissues and retain by extension into interproximal undercuts. It is readily removable for convenient home care.

Perio/Endo:

          A strong co-relation exists between periodontal and endodontal Rx. Endodontic Rx of periodontally compromised tooth would result in failure of Rx and tooth loss and vice versa.

Crown Lengthening:

          An apparently hopeless tooth with extensive subgingival caris, subgingival #, root perforation resulting from endodontics can be successfully restored after crown lengthening. It may be accomplished either surgically or combined orthodontic periodontic techniques depending on needs of patient and dental situation.

Ridge Augmentation Procedures:

          Alveolar ridge alteration most likely occurs due to advanced periodontal diseases. Periodontal plastic surgeries and hard tissue surgeries in the treatment option for establishing a proper soft tissue and bony contour to facilitate successful prosthetic reconstruction which requires close interaction between periodontist and prosthodontist.

          Slveolar tubercle should be removed surgically to provide stability to max denture. Trenclony and surgical splint is given for sulcus extension procedures.

          As life expentencies severely restored alveolar ridge is becoming more the rule than inception in prosthodontic practice. These procedures recreate an edentutions ridge with characteristics comparative with denture hearing.

          Use of bone/cartilage (Antologans/homologons), Alloplastic materials, sricalcium phosphate, hydroxyapatite or combination of osteotomy procedures have been tried over a temperature. One procedure that has shown success in past takes advantage of organic potential of homoepriotic bone marrow through we of particulate bone marrow and cancellous bone chips contained within a mesh. Soft tissue procedures are undertaken to reconstruct obliterated vestibules.

          Max anguentation procedures uses report  osteolony and doses # of maxi