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Evaluation of the Relationship Between Prosthodontics and Periodontics. a Review

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Evaluation of the Relationship Between Prosthodontics and Periodontics. a Review Romanian Journal of Medical and Dental Education Vol. 8, No. 8, August 2019 EVALUATION OF THE RELATIONSHIP BETWEEN PROSTHODONTICS AND PERIODONTICS. A REVIEW Odette-Elena Luca1, Ioana Martu1*, Ionut Luchian2*, Elena Luca1, Dragos Virvescu1, Vladina Andronache2,3, Monica Tatarciuc1, Silvia Martu2 1”Grigore T. Popa” University Medicine and Pharmacy, Faculty of Dental Medicine, Department of Prosthodontics, Iasi, Romania. 2”Grigore T. Popa” University Medicine and Pharmacy, Faculty of Dental Medicine, Department of Periodontology, Iasi, Romania. 3 PhD. Private Practice, Iasi, Romania. *Corresponding author: Martu Ioana [email protected] Luchian Ionut: [email protected] Abstract This article was aimed at addressing the key relationship between prosthodontics and periodontics. The impacts of healthy periodontium on longevity of prostheses were addressed. The interdisciplinary approach has been a trend for a comprehensive dental treatment. Within modern dentistry, periodontics and prosthodontics share an intimate and inseparable relationship in multiple aspects, including treatment plan, procedures execution, outcome achievement and maintenance. By controlling inflammation and preparing sites for proper prosthetic prostheses, periodontists no doubt can provide a solid foundation for successful prosthetic outcomes. On the other hand, prosthodontists could construct proper restorative margin, shapes and contacts that benefit the harmony of periodontium and prosthesis. Keywords: Periodontics, restorative, prosthodontics, biologic width. Introduction involvement, tooth mobility, the severity of bony destruction, etc. This review attempted to address Through identifying the etiology the key relationship between periodontics and contributing factors of periodontal and prosthodontics. Of all disciplines diseases, these prognositication systems within modern dentistry, periodontics and indicate the possibility of tooth prosthodontics have the strongest and the sustainability in short term and long term. most intimate connections. For As an integral portion of dental practice, prosthodontics, periodontal health plays an determination of individual teeth prognosis important role on the longevity of allows a virtual approach on restorations. interdisciplinary conversation for Prior to treatment plan, tooth treatment strategies. prognosis should be addressed both on The signs of active periodontal individual tooth and the overall dentition. inflammation include pocket formation, Several periodontal prognositication the presence of bleeding on probing or systems have been introduced based on suppuration, and tissue changes of gingiva. either periodontal stability1 or certain In addition, periodontal inflammation parameters [1-4], such as furcation results in soft tissue changes in terms of 51 Romanian Journal of Medical and Dental Education Vol. 8, No. 8, August 2019 texture, color, size and gingival and retention of food debris and consistency. It then leads to impaired determination invasion of “biologic esthetic outcomes by deteriorating the width”may also result in periodontal harmony between periodontium and inflammation. prosthesis. In addition to inflammation Biologic width. control, periodontists could offer a hand The dimension of dentogingival for soft and hard tissue management to complex, called "biologic width ", is a prepare sites for successful prosthetic cuff-like barrier that acts as a protective treatments. physiological seal around natural teeth. It Regular periodontal maintenance is possesses a selfrestoration capacity and a key to reduce the incidence of tooth or dynamic adaptability. The mean distance implant loss following prosthetic therapy. of epithelial and connective tissue Due to limitation of routine home cares, components are 0.97mm and 1.07mm, regular professional maintenance therapy respectively. However, the dimension is plays a key role on reduction of dynamic in particular the epithelial periodontal inflammation induced by attachment, varying from individuals [5]. plaque accumulation, especially in the Similar to natural teeth, a subgingival space. consistent width of peri-implant mucosa For those patients who had history was found adhering to the surface of the of periodontitis, regular supportive implant abutment. Histologically, it periodontal therapy is even more prevents further supragingival plaque beneficial to prevent further disease formation via a zone of healthy connective progression. Previous studies showed that tissue separating the inflammatory cell sites with treatment but without infiltration and alveolar bone crest [6,1]. maintenance had a 2 times higher tooth The violation of biologic width has been loss than the sites with regular widely discussed as a contributing factor maintenance after periodontal treatment which jeopardizes periodontal health [7,8]. [2,3]. A recent study even showed a 3 time Biologic width invading could result from higher tooth loss in the irregular compliers several reasons, such as extensive caries, comparing with patients with regular subgingival restorations, short clinical maintenance over a 5-year observation crown, and teeth fracture. period. In other words, regular compliance Clinically, the signs of biologic of periodontal maintenance is the key to width violation consist of pain, gingival prevent the recurrence of periodontal inflammation, localized gingival diseases and to maintain the integrity of hyperplasia, pocket formation, and loss of treatment outcomes8. periodontal apparatus. From periodontal point of views, several parameters should The impacts of prosthetic factors be taken into account for the feasibility of on periodontal health this surgery: esthetics, possible exposure Prostheses should be carefully of furcation involvement, remaining bony designed and performed, in harmony with support and crown/ root ratio for the future the surrounding periodontium, to maintain results. periodontal. Defective restorations Postoperatively, final prostheses contribute to disease progression by should only be delivered once the tissue increasing accumulation of dental plaque maturation was completed. A minimum of 52 Romanian Journal of Medical and Dental Education Vol. 8, No. 8, August 2019 6-8 weeks of healing period is highly (2.4%) in the patients with initiate recommended following surgical crown periodontitis [11]. lengthening that without bone resection. In spite of an indirect relationship between Hence, communication prior to treatments open contact and periodontal between periodontists and prosthodontists inflammation, it could be speculated from is essential to determine the treatment these studies that food impaction timeframe, feasibility of surgery and the contributes to increasing pocket depth and locations of restorative margins. clinical attachment level. Thus, clinicians The clinical significances of effects should avoid to place open contacts on marginal bone preservation may be between fixed prostheses. Meanwhile, questioned. In conclusion, the available through proximal cleaning should be data remained controversial and further addressed to patients. longitudinal studies are still needed. Restoration contours Adequate crown contours could Proximal relationship provide protection of gingival margins, Embrasure types, referring both allow cleansing action of the musculature horizontal and vertical dimensions of the and facilitate the access for oral hygiene interproximal spaces, show impacts on the [12]. Indeed, overcontour may have presence of interproximal papilla. Loss of negative influence on periodontium since interproximal papilla results in impaired it increases plaque retention [13,14]. esthetics and promotion of food impaction, Utilizing acrylic facings as standard aggravating periodontal destruction. As for overcontour, Sackett and Gildenhuys the distance from contact point to the compared tissue changes at 42 pairs of alveolar crest, the maximum of the experimental and control sites (adjacent distance should not exceed more than 5mm teeth) over a period of 42-49 days. 59% of to preserve the interdental papillae in mandibular test sites and 70% of maxillary natural dentition [9]. test sites showed significant gingival Contact types between prostheses inflammation in relation to overcontour. may also play a role on periodontal health. Besides, more than 50% of these The relationship between open contacts sites had increasing amount of gingival and periodontal destruction has been a sulcular fluid compared with their controls controversial issue since last century. To [15]. Restorative overhang is also verify the impacts of open contacts on considered as a contributing factor of periodontium, Jenberg and colleagues periodontal diseases. As a prevalent type conducted a cross-sectional study enrolling of restorative defects [16], filling excess 104 patients with unilateral open contacts. may aggregate the plaque accumulation In addition to greater prevalence of food which potentiates gingival inflammation impaction, the sites with open contacts and worsen the periodontal status [17,18]. presented greater pocket depth and clinical Meanwhile, inadequate crown reduction attachment loss although there was no for the restorative material should be significant difference for gingival index, avoided to prohibit the overcontoured bleeding and calculus index between crown. contact types [10]. Moreover, another cross-sectional The location of restorative study reported an increase of bone loss margins 53 Romanian Journal of Medical
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