Review Article Relationship Between Periodontics and Prosthodontics: The Two-Way Street Yung-Ting Hsu DDS, MDSc, MS Abstract Visiting clinical assistant professor, The interdisciplinary approach has been a trend for Department of Periodontics and Allied a comprehensive dental treatment. Within modern Dental Program, Indiana University, dentistry, periodontics and prosthodontics share Indianapolis, IN, USA an intimate and inseparable relationship in multiple aspects, including treatment plan, procedures execution, outcome achievement and maintenance. By controlling Nan-Chieh Huang DDS, MDSc, MS inflammation and preparing sites for proper prosthetic Resident, Department of prosthodontics, prostheses, periodontists no doubt can provide a solid Indiana University, Indianapolis, IN, USA foundation for successful prosthetic outcomes. On the other hand, prosthodontists could construct proper restorative margin, shapes and contacts that benet the Hom-Lay Wang DDS, MSD, PhD harmony of periodontium and prosthesis. This article Professor and Director of Graduate was aimed at addressing the key relationship between prosthodontics and periodontics. The impacts of Periodontics, Department of Periodontics healthy periodontium on longevity of prostheses were and Oral Medicine, School of Dentistry, addressed. In addition, how the restorative factors such University of Michigan, Ann Arbor, MI, as biologic width violation, retraction techniques and USA. Research Advisor, Eng. A.B. Research defective restorations, inuenced on periodontal/ peri- Chair for Growth Factors and Bone implant tissues were also discussed. This systematic Regeneration, King Saud University Riyadh, review also comprised the association between the Saudi Arabia presence of residual cement and the occurrences of peri-implant diseases. In short, frequent and efficient communications are essential between periodontists and prosthodontists through the entire treatment procedures Corresponding author: to ensure an overall successful treatment since both Hom-Lay Wang, DDS, MSD, Ph D. specialties share a common goal: to create pleasing Professor and Director of Graduate esthetic with a harmonious stomatognathic system. Periodontics Department of Periodontics and Oral Keywords: Periodontics, restorative, prosthodontics, Medicine implant, biologic width, inammation University of Michigan School of Dentistry 1011 North University Avenue Introduction Ann Arbor, Michigan 48109-1078, USA. omprehensive dental therapy is founded on team Tel: (734) 763-3383 works. Of all disciplines within modern dentistry, Fax: (734) 936-0374 Cperiodontics and prosthodontics have the strongest and E-mail: [email protected] the most intimate connections. For prosthodontics, peri- odontal health plays an important role on the longevity of restorations. On the other hand, defective prostheses may contribute to progression of periodontal diseases. To achieve successful treatment outcomes, periodontists and prosthodontist should cooperate in treatment plan, per- 04 Volume 4, Number 1, 2015 Review Article formance and maintenance. on periodontal/peri-implant inflammation 5-7 This review attempted to address the key remained inconclusive , mucogingival proce- relationship between periodontics and prosth- dures may also benefit esthetic outcomes and odontics. e interaction between periodontal oral health maintenance. health and prosthetic factors were discussed as Regular periodontal maintenance is a key well as the recent hot issues related to dental to reduce the incidence of tooth or implant loss implants. following prosthetic therapy. Due to limitation of routine home cares, regular professional maintenance therapy plays a key role on reduc- The impacts of periodontal/implant tion of periodontal inflammation induced by health on prosthetic therapy plaque accumulation, especially in the subgin- Prior to treatment plan, tooth prognosis gival space. For those patients who had history should be addressed both on individual tooth of periodontitis, regular supportive periodon- and the overall dentition. Several periodontal tal therapy is even more beneficial to prevent prognositication systems have been introduced further disease progression. Previous studies 1 based on either periodontal stability or certain showed that sites with treatment but without 2-4 parameters , such as furcation involvement, maintenance had a 2 times higher tooth loss tooth mobility, the severity of bony destruc- than the sites with regular maintenance after 2,3 tion, etc. rough identifying the etiology and periodontal treatment . A recent study even contributing factors of periodontal diseases, showed a 3 time higher tooth loss in the irregu- these prognositication systems indicate the lar compliers comparing with patients with possibility of tooth sustainability in short term regular maintenance over a 5-year observation and long term. As an integral portion of den- period. Besides, the results also showed that tal practice, determination of individual teeth the majority of these teeth were missing due prognosis allows a virtual approach on interdis- to periodontal origins. In other words, regular ciplinary conversation for treatment strategies. compliance of periodontal maintenance is the Overall prognosis is benecial to communica- key to prevent the recurrence of periodontal tions between lay people and professionals. diseases and to maintain the integrity of treat- 8 Active periodontal/peri-implant diseases ment outcomes . and contributing factors should be eliminated or controlled prior to prosthodontic construc- The impacts of prosthetic factors tions. The signs of active periodontal inflam- on periodontal/ peri-implant health mation include pocket formation, the presence Prostheses should be carefully designed of bleeding on probing or suppuration, and and performed, in harmony with the surround- tissue changes of gingiva. Without control- ing periodontium, to maintain periodontal/ ling the existing periodontal inflammation, a peri-implant health. Defective restorations cascade of adverse events of periodontal de- contribute to disease progression by increasing struction would take place and cause persistent accumulation of dental plaque and retention inammation, bone resorption and eventually of food debris. Invasion of biologic width may tooth loss. In other words, function and lifes- also result in periodontal inammation. pan of the prosthesis will be compromised if periodontal diseases remain uncontrolled aer Biologic width delivery. In addition, periodontal inflamma- The dimension of dentogingival complex, tion results in soft tissue changes in terms of called "biologic width (BW)", is a cuff-like texture, color, size and gingival consistency. It barrier that acts as a protective physiological then leads to impaired esthetic outcomes by seal around natural teeth. It possesses a self- deteriorating the harmony between periodon- restoration capacity and dynamic adaptability. tium and prosthesis. The compositions of BW include junctional In addition to inammation control, perio- epithelium and connective tissue attachment. dontists could offer a hand for soft and hard e mean distance of epithelial and connective tissue management to prepare sites for success- tissue components are 0.97mm and 1.07mm, ful prosthetic treatments. Surgical procedures, respectively. However, the dimension is dy- such as ridge and bone augmentation as well as namic in particular the epithelial attachment, 9 sinus liing, could be performed for future im- varying from individuals . Similar to natural plant sites to correct existing ridge deformities. teeth, a consistent width of peri-implant mu- Although the effects of mucogingival defects cosa was found adhering to the surface of the Journal of Prosthodontics and Implantology 05 Review Article 19 implant abutment. Histologically, it prevents esthetic demands or sites with bone removal . further supragingival plaque formation via a Hence, communication prior to treatments zone of healthy connective tissue separating between periodontists and prosthodontists the inflammatory cell infiltration and alveolar is essential to determine the treatment time- 10,11 bone crest . frame, feasibility of surgery and the locations The violation of BW has been widely of restorative margins. discussed as a contributing factor which jeop- Most researchers believe that BW is one of 12,13 20,21 ardizes periodontal health . BW invading the causes of early implant bone loss . Dur- could result from several reasons, such as ex- ing the initial phase of implant healing, peri- tensive caries, subgingival restorations, short implant bone remodeling is from the process clinical crown, and teeth fracture. From hu- of BW reformation to allow a stable so tissue 22 man autopsies, Vacek and coworkers reported barrier . In addition, the locations of micro- greater length of epithelial aachments around gaps and smooth/rough-surface interfaces may 14 restored teeth than non-restored teeth . In be associated with the length of peri-implant 23,24 the group with supracrestal amalgam restora- BW . us, one of the strategies to prevent tions, BW violation would also lead to signi- early implant bone resorption is control of cant increases of gingival recession and crestal biologic width and microgap. In 2006, Laz- 12 bone loss . Resulting from the breach of BW, zara and Porter introduced the concept of histologically, aachment loss will be found to "platform-switching" for inward horizontal reestablish the certain dentogingival junction repositioning