Areas of the Mouth (ref. 1)
Teeth
Soft tissues
Cheeks
Hard palate and Soft Palate
Vestibule of the oral cavity


Figure 1.

Assessment of gingival health (ref. 2)
Why is it Important?
Periodontal disease can lead to tooth loss.
Patients demanding a highly esthetic final restoration require healthy gingival tissues (correct contour, texture and color) for optimal results (see Figure 2a).

Figure 2a. Healthy tissues.

Figure 2b. Unhealthy tissues.
Unhealthy tissues (those which are red, inflamed and bleeding) complicate the crown and bridge procedure.
Unhealthy tissues make it very difficult to obtain an acceptable impression because blood may pool on the margin of the prepared tooth (see Figure 2b).
Cementation of the final restoration requires a dry field. A dry field cannot be accomplished when tissues bleed to the touch. (see Figure 3).

Figure 3. Unhealthy, bleeding tissues.
Gingivitis
Treatment Considerations
1. Patient must be involved! Plaque must be controlled with tooth brushing/flossing.
2. Scaling and polishing – supragingival and slightly sub-gingival removal of mineralized plaque (calculus) from the teeth is accomplished using sharp instruments referred to as scalers (see Figure 4).
3. Root planing – removing plaque and calculus from the root surfaces of the teeth is accomplished by using an instrument referred to as a curette. This procedure is generally performed under local anesthesia (see Figure 5).
4. Defective restorations, which are accumulating excessive plaque, should be repaired or replaced.

Figure 4. Scaling.

Figure 5. Root Planing.
NOTE: The crown and bridge procedure should not proceed until tissue health has been restored.
Advanced Periodontal Disease
Treatment Considerations
Surgery may be required (e.g. gingivectomy, tissue regeneration, etc.)
Treatment generally referred to periodontist.
Long-term, lab-fabricated temporaries may be worn while tissues are healing. Provisional restorations provide an important "preview" of both fit and appearance of final restoration. Well-made provisionals also provide an excellent interface for gingival healing.
NOTE: The crown and bridge procedure should only proceed when tissue health has been restored. Advanced periodontal therapy may require several months of treatment.




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