December 17, 2018 at 4:38 pm #1263Archives_AdminKeymaster
A forty-one year old female presented with fixed bridges from #6 to #8 and #9 to #11 with lateral incisors replaced with pontics. The tissue on the facial surfaces of the abutment teeth #6, #8, #9, and #11 presented with inflamed granulomatus tissue. There was not bone on the surfaces of the roots below the inflamed tissue. I advised the patient, an attorney, that no matter was performed recession would develop.
What would the etiology be for this problem aside from encroachment of biologic width? What are suggestions for treatment?
Do you have CBCT scan and pics you can share?
I am sorry I don’t
I wish I had a copy of this article by John Kois published in Dental Economics. Even though (I can’t believe it) the article is 19 years old, it’s still one of the most thoughtful inspections of why soft tissues get erythematous around crowns. And a main point of the article? Inflammation on the direct facial is almost always related to biologic width impingement on the interproximals, NOT BWI on the direct facial. If anybody out there has the article, maybe you could scan it and share it with us.
Gut feelings are that there was never much, if any bone on the facials. The teeth may have been orthodontic-ally re positioned through the bone (does not happen if we listen to Colin and do PAOO) or may have anatomically been located out there in the first place. (Look at the recent article showing less than 1/2 mm of facial bone on most anterior teeth. I know Dominic has the reference on his fingertips, I don’t.)
Why will recession necessarily develop if:
1. Any biologic width encroachment is corrected
2. The occlusion is proper
3. The patient is maintained on an occlusal guard to prevent anterior discursive movements from making the situation worse
4. Periodontal regenerative therapy is performed on the facial surfaces of the teeth
5. Ideal restorative therapy is performed to minimize cement excess, get excellent finishing lines and emergence profile and to enable ideal maintenance, both professional and personal, of the site.
Lloyd – I’ll see if I can find the article.
Thanks for the acknowledgement.
In support of your statement, I have attached two PDF files. The first is my patient this morning.
It is highly unlikely that if his treatment had been provided at that time with PAOO, there is less risk of relapse, recession, root resorption. Of course, other factors come into play relative to relapse.
He was a previous comprehensive orthodontic patient with , four bicuspid extraction. Note the extent of relapse. Unfortunately, he is unable to undertake orthodontic therapy at this time, so I am completing gingival grafting at various sites. Not the recession areas, and of course, lack of bone support associated with the lesion. Thus my graft includes both hard and soft tissue agents. However, note where there is adequate bone, the appropriate soft tissue support.
Second document is a copy of my paper demonstrating evidence for this concept.
Hope all is well – enjoy the summer.
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