| Assessment of gingival health (ref. 2) |
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Why is it Important? |
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| Patients demanding a highly esthetic final restoration require healthy gingival tissues (correct contour, texture and color) for optimal results (see Figure 2a). |
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Figure 2a. Healthy tissues. |
Figure 2b. Unhealthy tissues. |
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| Unhealthy tissues (those which are red, inflamed and bleeding) complicate the crown and bridge procedure. |
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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). |
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Cementation of the final restoration requires a dry field. A dry field cannot be accomplished when tissues bleed to the touch. (see Figure 3). |
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Figure 3. Unhealthy, bleeding tissues. |
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Gingivitis |
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| Treatment Considerations |
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Patient must be involved! Plaque must be controlled with tooth brushing/flossing. |
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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). |
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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). |
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Defective restorations, which are accumulating excessive plaque, should be repaired or replaced. |
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Figure 4. Scaling. |
Figure 5. Root Planing. |
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NOTE: The crown and bridge procedure should not proceed until tissue health has been restored. |
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Advanced Periodontal Disease |
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| Treatment Considerations |
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Surgery may be required (e.g. gingivectomy, tissue regeneration, etc.) |
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Treatment generally referred to periodontist. |
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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. |
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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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