Adobe Systems Restorative dentistry I. 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 lenka.roubalikova@tiscali.cz 14 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 lroubalikova@gmail.com 20 21 IMG_2587 bozeken po ging lroubalikova@gmail.com lenka.roubalikova@tiscali.cz 22 homolkavych homolkapreparace homolkamatrice1 homolka3 homolka4 Gingivectomy Gingivoplasty GIC as a temporary lenka.roubalikova@tiscali.cz 23 postfree1 postfree4 postfree11 lenka.roubalikova@tiscali.cz FRC výztuha klus01 IMG_2164 Adobe Systems Extrusion ̶ ̶Extrusion orthodontic ̶Fast ̶Surgical 24 Adobe Systems lenka.roubalikova@tiscali.cz 27 Tlachopg Resorpce lenka.roubalikova@tiscali.cz 28 Tlach foto Tlachfoto1 Tlachfoto3 29 30 The story continues….