Ksenija JorgiÊ-Srdjak1

Periodontal and Prosthetic Aspect Darije PlanËak1
Tomislav MariËeviÊ1
of Biological Width Mick R. Dragoo2
Andrija Boπnjak1

Part I: Violation of Biologic Width 1Department of Periodontology
School of Dental Medicine
University of Zagreb, Croatia
2Department of Fixed
Prosthodontics
School of Dental Medicine
University of Zagreb, Croatia
3Private practice, Escondido,
USA

Summary Acta Stomatol Croat
2000; 195-197
This review gives the wide aspect of the complex question of biologic
width and represents an attempt to answer some of the demands in
relation to it. First of all, it debates the problems that occur after REVIEW
improper margin placement in the periodontium. Initially, the dimen- Received: July 4, 2000
sions of biologic width are contemplated and then margin placement,
is discussed and the success of restorative procedures and reasons for Address for correspondence:
failure. Andrija Boπnjak
Key words: biologic width, margin placement. Department of Periodontology
School of Dental Medicine
GunduliÊeva 5, 10000 Zagreb
Croatia

Introduction periodontal health and removal of irritation that
might damage the periodontium (prosthetic restora-
A great part of periodontal literature deals with tions, for example). The millimeter that is needed
the checking, reconstruction and maintenance of from the bottom of the junctional epithelium to the
biologic width. This, in Croatian literature, rel- tip of the alveolar bone is held responsible for the
atively unknown term, deserves to be closely lack of inflammation and bone resorption, and as
explained. Gargiulo et al (1) reported in 1961 a such the development of periodontitis. The dimen-
certain uniformity of the dimension of some com- sion of biologic width is not constant, it depends on
ponents of biologic width: the location of the tooth in the alveola, varies from
• mean depth of the histologic sulcus is 0.69 mm, tooth to tooth, and also from the aspect of the tooth.
• mean junctional epithelium measures 0.97 mm Its constancy (is only one - it) can only be found in
(0.71 to 1.35 mm), healthy dentition (4,5,6).
• mean supraalveolar connective tissue attachment There is a problem in determining biologic
is 1.07 mm (1.06 to 1.08 mm). width. It does exist, but clinically, it is impossible
The total of the attachment is therefore 2.04 to define. If the gingiva looks healthy, and does not
millimeters (1.77 to 2.43 mm) and is called the bleed on probing, one can suspect that the histologic
biologic width (2,3), essential for preservation of sulcus (which has been destroyed while probed) of

Acta Stomatol Croat, Vol. 34, br. 2, 2000. ASC 195

Most dentists daily answer a question of great 5. or second factor is the ultimate success of the restora.25 mm of hard tooth many patients did choose the optimum gingival substance above the bone margins is necessary for health offered by supragingival margin place- a correctly prepared restoration placement. who proved that 3 mm understood the circumstances and were given a between the preparation margin and alveolar bone choice.25). First are the shape and the method sitivities.Ksenija JorgiÊ-Srdjak et al. The result is advanced periodontitis. Vol. The ultimate success of the restoration Subgingival placement of the crown and preparation A number of factors hold some importance for margins potentially endanger biologic width and the success of a prosthetic restoration. 2. Subgingival extension of caries. However. Removing plaque.10. If the biologic width is 1. ment was advocated for teeth in which insuf- 196 ASC Acta Stomatol Croat. some tion on a daily basis (easiest supragingivally) authors (11-20) claim that there will be no place left 2. Verification of the marginal integrity of the has been proved that even marginally adapted restoration (easiest supragingivally) prosthetic structure can have negative effects on the periodontium. lead to periodontal reaction. It 4. dentists do not analyze tooth visibility when deciding on margin placement for esthetic appearance. had it been placed subgingivally. Prosthetics can lead to greater plaque 3. Fit and finish of the restoration and removal of accumulation.5 mm that will facilitate the following (4): subgingivally. and maintaining the restora- violated during the preparation of the tooth. In the past.20. 4. flossing. a study pub- junctional epithelium and sulcus.23. Avoiding changes in gingival contour (easiest of the connective tissue attachment on the tooth supragingivally) root. This means that the margin of a It is desirable to place the margin in a location restoration may not be put more than 0.5 mm deep. all requirements 1. Preparation of the tooth and finishing of the for the maintenance of periodontal health can be margin (easiest supragingivally) established. subgingival margin place- tion. restorations. Esthetic requirements Nevins and Skurow (21) have defined the of the patients often call for intracrevicular biologic width as the total of supracrestal fibers. the restoration without damaging the marginal fit Violated biologic width can result in uncontrolled or scratching the restorative material (easiest bone resorption and might grow over the quantity supragingivally) of the bone necessary for the supralimbal insertions 3. Good oral hygiene and sulcus or subgingivally? Two basic factors should be local fluoride treatment resolve most root sen- taken into account. Subgingival margin placement importance: where to place the preparation margin. fractures.8. Duplication or the margins with impressions that There are literature reports of unfavorable effects can be removed past the finish line without of restorative therapy on periodontal tissue tearing or deformation (easiest supragingivally) (7. Such ment. placement of margins.24. improved esthetic claims have also been substantiated by other attempt of a subgingival margin. over the less healthy. Wagenberg (22) lished by Watson and Crispin (28) showed that concluded that at least 5 to 5. 34. which depends upon the therapist. The 6. 2000. With this in mind. The study also showed that 83% of maintains periodontal health for 4 to six months.10). of preparation. Brushing. which is influenced by a number of items. they can incite inflammation as well excess material (easiest supragingivally) as add to the progression of periodontal disease. Improving the esthetics. . br. is only a temporary solution if the gingival supragingivally. 2.9. if the patients authors (6.9. at the beginning of the gingival recession progresses. and only 64% of dentists actually Margin placement and biologic width assess the patient’s desires before deciding where to place the margin (28). calculus and performing for the attachment and the result in the development periodic inspection of the marginal integrity of of attachment loss and pocketing can be observed. Root sensitivity. Violation of Biological Width such a healthy or treated tooth was approximately Preparation 0.

restoration whose margin lies supragingivally is less itive effect on gingival health. following develops (4): 1. These factors play a great role in maximally compromises the esthetic component plaque accumulation and periodontal health of a and is as such unacceptable for the patient. this course of action become exposed. Opaque ceramic parts. this complex (tooth. greater length and surface area. for increased retention. potential to be ideal. develop. whose thin metal margin is usually oxidazed. restoration margins.29-34) loss. the peri- is almost impossible to ideally finish the margins of odontologist will start with an intensive oral hygiene crowns and veneers (22). 2. This happens in cases where the There is a special stress on metal-ceramic crowns. Patients with these findings always end up at a duced directly or indirectly. cementum and crown) can 2. The part. everyday findings. There is a clear connection If the biologic width is violated. the moment it the best way to achieve this is preprosthetic becomes too tight. decide on surgical periodontal treatment. often periodontologist. Different parts of ligament and bone) develop. ASC 197 . and periodontal disease (4). whether they are pro. the greater is the possibility from supragingival margins. as well as periodontitis. It is important to mention that every that supragingival placement has a substantial pos. which and gingivitis. Teeth with sub. compared to a restoration gingival margins show higher inflammation index whose margin lies supragingivally. These problems can be met halfway by proper showed that marginal infection is most commonly casting techniques and polishing of the margins of connected with subgingivally placed margins. Oral hygiene maintenance in such establishes an adequate biologic width and places is impossible. Bone loss under the preparation margin that Reasons for failure violated the biologic width. also prognosis for the tooth. br. bacteria colonizing areas at which. Today. Hyperplasia is most frequently found in altered passive eruption and subgingivally placed Gingival inflammation. result in localized inflammation surgical crownlengh tening procedure. inflammatory response and progress of attachment Research in animals and humans (24. Localized gingival hyperplasia with minimal abraded. patient (35-41). clinical signs being chronic allows correct margin placement. Acta Stomatol Croat. air 3. can be. Pocket and pro- A problem arises in cases where subgingival gressive periodontal tissue loss (periodontal placement is absolute necessary. After comprehensive examination. it is impossible between plaque accumulation. but can never be polished. which are coarse.Ksenija JorgiÊ-Srdjak et al. values than sound teeth. and restorations. Violation of Biological Width ficient or questionable retention could be gained deeper the margins lie. and. and sometimes It is precisely these places which represent ideal more parallelism. 34. depending on re-evaluation for incorrect margins is the impossibility to perform results. Gingival recession and localized bone loss easily become the location of plaque accumulation. proper casting and/or margin finishing when the Surgical procedures are described in the second margin is already located subgingivally (26). The most frequent reason programme. caused by improperly finished prosthetic restorations. labiobuccal bone is thin (43). are frequent. Vol. One or more of the restorations. Such margins. and therefore is bone loss. especially if it is known that it case history and periodontal charting. caused by inadequate to maintain periodontal health. 2000. This was to give that it is unpolished (42). Although this represents the best rough.