By: Pankey Gram
Topic Originally appeared on PankeyGram.org
Gingival crevice is the space between the marginal gingiva and the tooth surface. Keeping it healthy, means knowing effective tooth preparation techniques that don’t block the passage of gingival crevice fluid with restoration materials.
Many soft tissue inflammation, like gingivitis and periodontitis can occur as a result of not being able to have a free gingival margin, that can be brushed and flossed easily by the patient. In that case a gingival crevice fluid is accumulated and a local swelling is observed clinically.
Therefore, when restoring a tooth it is challenging but critical to maintain the gingival margins healthy for the long run.
The Goal of Restorative Treatment
The goal with a restoration should be to limit the possibility of inflammation or gingivitis post-treatment. This can only be accomplished if the intracrevicular margins, meaning those placed within and limited to the gingival crevice are properly created.
There are multiple techniques needed for this goal, but one critical piece is how the tooth is prepared.
Gingival Tooth Preparation Guidelines
The ideal gingival tooth preparation has two important considerations; distinct gingival margins and sufficient tooth reduction.
If you have to extend the material you are using into the gingival crevice, then you must ensure the intracrevicular tooth reduction is large enough to account for the cosmetic material that will inevitably recess into the tooth’s normal shape.
One thing that absolutely must be avoided is forcing cosmetic material out into the tissue. This can occur as a result of under reducing the cervical aspect of the tooth. The negative effects of this problem are plaque growth, decreasing the patient’s ability to adequately cleanse the area, and a crevice that appears flabby and retractable. You’ll see these problems happening because as the cervical bulge protrudes, it distends the crevicular epithelium and connective tissue.
Sometimes, you may put plenty of care and precision into your effort and still find that the tissue is injured during your tooth preparation.
Simple Guidelines to Protect Gingival Tissue
To avoid this, you can consistently follow these simple guidelines:
- Don’t overextend the rotary instrumentation circumferentially.
- Avoid permanently damaging surrounding tissue during retraction or while making impressions.
- Create polished and excellently contoured margins, as well as a great fit, for the interim restoration.
- Prevent retention of temporary cement in the gingival crevice.
- Sustain control of intracrevicular plaque.
Long-Term Gingival Health and Restorative Success
When restoring a tooth, you can’t just put a restoration onto it, without taking care of the surrounding tissues. Maintaining a healthy gingiva and prepping tooth correctly so enough space is created for restoration without compromising sulcular fluid is important for long-term successful outcomes.
Follow these guidelines, and you’ll be on your way to long-lasting results. If you are curious to learn more about soft tissue considerations and tooth preparation guidelines, for aesthetic and functional treatment planning, including composites, ceramics, or zirconia restorations, visit The Pankey Institute educational courses.
