Adobe Systems
Restorative dentistry III.
4 th lecture
Subgingival defects

Main problems
 Substantial loss of hard dental tissues

Subgingival cervical borders – difficulties with dry operative field
(bleeding, sulcular liquid)
Adhesive procedures in region without enamel
– consider selfetching adhesive

          SUBGINGIVAL DEFECTS
Technical parameters:
Possibility to keep the operating field dry
Biological parameters: measurement of distance between clean gingival border and insertion of
periodontal ligament or crest of alveolar bone using periodontal probe and/or xray.
Biological width

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Dentogingival complex
 DGC =
biological width
2-4mm +
sulcular depth
1-3mm
= 3-7 mm
Biological width
Epithelium junction
 1-2 mm+
Connective tissue junction
-supraalveolar fibers
1 -2 mm
= 2 - 4 mm
Gargiulo AW, Wentz FM, Orban B
(J Perio 1961)
Vacek JS, Gher ME, Assad DA, Richardson AC,
Gambaressi LI
(Int J Perio & Rest Dent 1994)
1 - 2 mm
1- 2 mm

Classification of subgingival defects
1. Ruberdam is possible to use, gingival border can be seen.
2. Rubberdam does not allow complete isolation of operating field, biological width is ok.
3. Subgingival defect, biological width is affected.

Solution
1. Margin elevation – cervical margin relocation  using flowable material or composite filling
materiál
 2. Gingivectomy + gingivoplasty
 3. Elongation of clinical crown – crown lenghtening (gingivectomy + ostectomy)
Reconstruction: direct or indirect

Cervical margin relocation
SEQUENCE OF OPERATION – MARGIN RELOCATION •
 Consider possibility of effect of rubberdam and biological width •

Cervical margin relocation
Application of rubberdam
Matrix band – can be cut (appr.3 - 5 mm)
Tihgtening of the matrix with the retainer
Insertion of a wooden wedge
Adhesive procedure  consider selfetching adhesive system
Flowable
Composite







New margin



obr04 IMG_2084 onlay1






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lenka.roubalikova@tiscali.cz
klus01 IMG_2164

Gingivectomy and gingivoplasty
Cutting gingiva and shaping it anatomically :
 Scalpel - Laser - Cauter




Crown lenghtening
Surgical procedure based on gingivectomy, gingivoplasty and ostectomy.
Closed and open







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IMG_2587 bozeken po ging
lroubalikova@gmail.com

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homolkavych homolkapreparace homolkamatrice1 homolka3 homolka4
Gingivectomy
Gingivoplasty
GIC as a temporary

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postfree1 postfree4 postfree11
lenka.roubalikova@tiscali.cz
FRC výztuha
klus01 IMG_2164

Adobe Systems
Extrusion
̶
̶Extrusion orthodontic
̶Fast
̶Surgical
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Adobe Systems



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Tlachopg
                                   Resorpce

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Tlach foto Tlachfoto1 Tlachfoto3

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The story continues….