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04
INTRODUCTION
Concept
of Biologic width is based on studies and analyses by, Gottlieb (1921), Orban and Khler (1924), and Sicher (1959)
Cinical Periodontology & Implant Dentistry 5th edition Jan Lindhe
INTRODUCTION
Ingber et al(1977) first described Biologic Width and credited D.Walter Cohen for first coining the term.
The dimension of biologic width is not constant, it depends on the location of the tooth in the arch, varies from tooth to tooth, and also for each aspect of the tooth.
Its constancy can only be found in healthy dentition.(De Wall etal 1993) It varies from 0.75 to 4.3mm in length.
Biologic width is the natures approach for protecting the periodontal ligament and alveolar crest
It acts as a shield which endures trauma, both mechanical and bacterial, to ensure longevity of a tooth and restoration.
Its integrity is indicative of gingival health, and is a guide for restorative procedures.
Attempt to access sound tooth structure Existing caries (Class V ,II ) Resorption defects Traumatic injury (Subgingival fractures) Iatrogenic Improper identification of sulcus depth Injury during tooth preparation Overextended subgingival restorations
J KOIS Periodontology 2000. Val. 11, 1996,29
IMPLICATIONS OF BIOLOGIC WIDTH VIOLATION Persistent Gingival Bone Loss with Inflammation Gingival Recession
Chronic Gingival Inflammation Localised Gingival Hyperplasia with minimal bone loss Intrabony pocket formation
BONE SOUNDING
RADIOGRAPHIC INTERPRETATION
Determine the finish line prior to surgery Bone sounding prior to surgery is performed for establishing the biologic width. The biologic width requirements will determine the amount of alveolar bone removal
The combination of biologic width and prosthetic requirements determines the total amount of tooth structure necessary for exposure.
Tooth surface topography, anatomy, and curvature are analyzed for determining a. Osseous scallop b. Gingival form
Smukler and Chaibi (1997)
Ingber et al (1977) suggested that a minimum of 3 mm required from the restorative margin to the alveolar crest to permit adequate healing and restoration of the tooth.
Periodontol 2003
FERRULE EFFECT
For post and core restorations 5-6mm of exposed tooth structure should be present above alveolar crest
Adequate
Inadequate
Gingival recession following osseous reduction. Loss of interdental papilla Gingival contour of treated tooth crown higher than adjacent teeth. Loss of attachment apparatus and recession in the adjacent teeth Following removal of bony support, an inverse and Unfavorable crown root ratio.
ORTHODONTIC EXTRUSION
Slow orthodontic extrusion force Rapid orthodontic extrusion with supracrestal fibrotomy Ref:Felippe LA, Monteiro Junior S etal,Quintessence Int. 2003.