Restorative dentistry I. 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 lroubalikova@gmail.com 4 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 Gingivectomy and gingivoplasty • •Cutting gingiva and shaping it anatomically : • • Scalpel - Laser - Cauter • lenka.roubalikova@tiscali.cz 14 homolkavych homolkapreparace homolkamatrice1 homolka3 homolka4 Gingivectomy Gingivoplasty GIC as a temporary Crown lenghtening • •Surgical procedure based on gingivectomy, gingivoplasty and ostectomy. • • •Closed and open lroubalikova@gmail.com 18 Extrusion • •Extrusion orthodontic •Fast •Surgical Definujte zápatí – název prezentace nebo pracoviště 19