0.97+1.07=2.

04

BIOLOGIC WIDTH-THE NO BREACH ZONE

PRESENTED BY: DR. POOJA BHASALE 1 st YR P.G. STUDENT DR. D.Y. PATIL DENTAL COLLEGE NAVI MUMBAI GUIDED BY: DR . Q.J.A . SHAKIR(PROFESSOR) DR. ARVIND SHETT Y(HOD & PROF

WHAT IS BIOLOGIC WIDTH?

INTRODUCTION

Concept

of Biologic width is based on studies and analyses by, Gottlieb (1921), Orban and Khler (1924), and Sicher (1959)
Cinical Periodontology & Implant Dentistry 5th edition Jan Lindhe

INTRODUCTION

Ingber et al(1977) first described Biologic Width and credited D.Walter Cohen for first coining the term.

The dimension of biologic width is not constant, it depends on the location of the tooth in the arch, varies from tooth to tooth, and also for each aspect of the tooth.

Its constancy can only be found in healthy dentition.(De Wall etal 1993) It varies from 0.75 to 4.3mm in length.

SIGNIFICANCE OF BIOLOGIC WIDTH

Biologic width is the natures approach for protecting the periodontal ligament and alveolar crest

It acts as a shield which endures trauma, both mechanical and bacterial, to ensure longevity of a tooth and restoration.
Its integrity is indicative of gingival health, and is a guide for restorative procedures.

REASONS FOR BIOLOGIC WIDTH VIOLATION

Attempt to access sound tooth structure Existing caries (Class V ,II ) Resorption defects Traumatic injury (Subgingival fractures) Iatrogenic Improper identification of sulcus depth Injury during tooth preparation Overextended subgingival restorations
J KOIS Periodontology 2000. Val. 11, 1996,29

IMPLICATIONS OF BIOLOGIC WIDTH VIOLATION Persistent Gingival Bone Loss with Inflammation Gingival Recession

Carranzas Clinical Periodontology 10th edition

THIN AND SCALLOPED PERIODONTAL BIOTYPE

THICK AND FLAT PERIODONTAL BIOTYPE

Gingival Recession Horizontal Bone loss

Chronic Gingival Inflammation Localised Gingival Hyperplasia with minimal bone loss Intrabony pocket formation

HOW DO WE IDENTIFY BIOLOGIC WIDTH VIOLATION?

ASSESSING THE RESTORATIVE MARGINS WITH PROBE

BONE SOUNDING

RADIOGRAPHIC INTERPRETATION

CORRECTING BIOLOGIC WIDTH VIOLATIONS

Can be corrected or prevented by 1.Surgically removing bone

2.Orthodontic extruding the tooth

FACTORS DETERMINING THE TREATMENT PROTOCOL

PRESURGICAL TREATMENT ANALYSIS

Determine the finish line prior to surgery Bone sounding prior to surgery is performed for establishing the biologic width. The biologic width requirements will determine the amount of alveolar bone removal

Smukler and Chaibi (1997)

PRESURGICAL TREATMENT ANALYSIS

The combination of biologic width and prosthetic requirements determines the total amount of tooth structure necessary for exposure.

Tooth surface topography, anatomy, and curvature are analyzed for determining a. Osseous scallop b. Gingival form
Smukler and Chaibi (1997)

DECIDING THE SAFETY LINE

Ingber et al (1977) suggested that a minimum of 3 mm required from the restorative margin to the alveolar crest to permit adequate healing and restoration of the tooth.

Additional 0.5mm of bone removed as safety zone. (Kois1996)

Wagenberg et al.(1989),suggested that atleast 55.25mm of tooth structure should be above the osseous crest
Ref: Padbury Jr A, Eber R, Wang H-L.,J Clin

Periodontol 2003

FERRULE EFFECT
For post and core restorations 5-6mm of exposed tooth structure should be present above alveolar crest

This takes in account the 2mm ferrule length

SURGICAL CROWN LENGTHENING

Width of Attached gingiva

Adequate

Inadequate

Flap with Osseous reduction

Apically Repositioned Flap with Osseous Reduction

FLAP WITH OSSEOUS REDUCTION

FLAP WITH OSSEOUS REDUCTION

Atlas of Cosmetic and Reconstructive Periodontal Surgery 3rd edition Cohen

APICALLY REPOSITIONED FLAP WITH OSSEOUS REDUCTION

Atlas of Cosmetic and Reconstructive Periodontal Surgery 3rd edition Cohen

LIMITATIONS OF SURGICAL CROWN LENGTHENING

Gingival recession following osseous reduction. Loss of interdental papilla Gingival contour of treated tooth crown higher than adjacent teeth. Loss of attachment apparatus and recession in the adjacent teeth Following removal of bony support, an inverse and Unfavorable crown root ratio.

ORTHODONTIC EXTRUSION

Slow orthodontic extrusion force Rapid orthodontic extrusion with supracrestal fibrotomy Ref:Felippe LA, Monteiro Junior S etal,Quintessence Int. 2003.

SLOW ORTHODONTIC FORCE EXTRUSION

RAPID ORTHODONTIC EXTRUSION