The perio-restorative interrelationship-expanding the horizons in esthetic dentistry

Abstract

The astute clinician strives to create a beautiful smile paying due heed not only to the gleaming white teeth, but also to the health of the surrounding tissues. A sound periodontium provides a firm foundation for an esthetic and functional prosthesis. Conversely, when restorations are designed to be self-cleansing and promote gingival health, the tissues present a harmonious esthetic blend at the restorative -gingival interface. This review paper aims at exploring the potential of an interdisciplinary approach to achieve this end. This involves incorporating a comprehensive treatment plan, paying close attention to both soft and hard tissues around teeth and implants before, during, and after restorative procedure. Key aspects of the restoration and partial denture design that have a direct effect on the periodontium include restoration contour, margin adaptation, margin placement, prosthetic and restorative materials, design of fixed and removable partial dentures, restorative procedures and occlusal function. Special emphasis is paid to the consequences of violation of biologic width, that leads to incessant inflammation, possible recession and unsightly exposure of crown margin. Periodontal considerations include control of periodontal inflammation, correction of the gingival architecture, and periodontal maintenance. A search of articles from Pubmed and Medline with the keywords restorative-alveolar interface, methods of gingival retraction and biologic width was conducted. A total of 430 abstracts were collected, of which most relevant articles were included in this paper. Clinical Relevance to Interdisciplinary Dentistry To promote restoration and pontic designs that promote favorable tissue response. To stress the importance of preserving biologic width to all dental practitioners To shed light on iatrogenic damage to the periodontium from certain materials and procedures. To unveil the potential of periodontal plastic surgery techniques like augmenting attached gingiva and esthetic crown lengthening prior to restorative procedures when indicated. To emphasize the need for recall and maintenance therapy. All the above concepts can be successfully implemented into clinical practice.