Biologic Width and Violations in Dentistry

Questions and Answers

What is the primary reason for performing crown lengthening?

To expose subgingival caries (correct)

To alleviate tooth sensitivity

To improve aesthetics of the smile

To enhance tooth color

Which of the following is NOT an indication for crown lengthening?

Short clinical crowns

Presence of enamel caries (correct)

Poor esthetic appearance due to gingival levels

Restorative margins placed below the gum line

What is meant by biological width in restorative dentistry?

The distance from the gingival margin to the alveolar crest

The natural seal created around teeth (correct)

The maximum height of the crown

The total length of the tooth root

Which method is NOT used to evaluate a violation of biological width?

Crown margin adjustment Signup and view all the answers

What condition indicates a violation of biological width?

Gingival recession Signup and view all the answers

What is a contraindication for crown lengthening procedures?

Presence of periodontal disease Signup and view all the answers

What is the average measurement of the junctional epithelium in biologic width?

0.97 mm Signup and view all the answers

Which aesthetic concern is a reason for crown lengthening?

High lip line Signup and view all the answers

Which radiographic feature may suggest a violation of biological width?

Bone loss around the restoration Signup and view all the answers

What does the biologic width violation indicate regarding periodontal health?

A breach of the space needed for the attachment of periodontal tissues. Signup and view all the answers

What is the primary purpose of the parallel profile radiographic technique?

To measure the dimensions of the dento gingival unit accurately. Signup and view all the answers

Why might crown margins be placed supragingivally during a crown lengthening procedure?

To assist with impression accuracy Signup and view all the answers

Which margin placement guideline applies when the sulcus probes more than 1.5mm?

Place the margin 12 mm below the gingival crest. Signup and view all the answers

Which type of margin is associated with the greatest biologic risk?

Subgingival margin. Signup and view all the answers

Which statement about equigingival margins is accurate based on current understanding?

Equigingival margins do not significantly impact the health of the periodontium. Signup and view all the answers

What is one of the primary indications for crown lengthening?

To improve the aesthetics of a smile. Signup and view all the answers

What is a contraindication for performing crown lengthening?

Presence of periodontal disease. Signup and view all the answers

How can probing under local anesthesia assist in identifying biologic width?

It measures the depth of the gingival sulcus. Signup and view all the answers

What is a common location where biologic width violation is likely to be found?

Mesiofacial and distofacial line angles of teeth. Signup and view all the answers

Which of the following is true regarding the supragingival margin placement?

It has the least impact on the periodontium. Signup and view all the answers

What is the primary definition of crown lengthening?

Any procedure that increases the amount of tooth exposed supragingivally Signup and view all the answers

Which of the following is NOT an indication for performing crown lengthening?

Reduction of tooth sensitivity Signup and view all the answers

Which method is used in surgical crown lengthening?

Gingivectomy Signup and view all the answers

What is one reason why crown lengthening might be contraindicated?

Presence of adequate tooth structure Signup and view all the answers

Which of the following is a method of crown lengthening?

Apically positioned flap with osseous resection Signup and view all the answers

What procedure is indicated for gingival overgrowth?

Gingivectomy or gingivoplasty Signup and view all the answers

Which statement accurately describes a biological width concern?

The distance from the bone to the gingival margin Signup and view all the answers

Which procedure improves inadequate tooth structure for restoration?

Forced eruption with fiberotomy Signup and view all the answers

What is the primary purpose of crown lengthening?

To increase the height of the tooth structure for better aesthetics Signup and view all the answers

What is a common goal of esthetic periodontal corrective procedures?

To improve the harmony between the teeth and gums Signup and view all the answers

When might a surgical approach to crown lengthening be preferred?

When orthodontic techniques are inadequate Signup and view all the answers

Which method is NOT a recognized technique for surgical crown lengthening?

Crown expansion Signup and view all the answers

In what situation should gingivectomy be performed for crown lengthening?

When available keratinized gingiva is adequate (≥2 mm) Signup and view all the answers

What is the contraindicator for performing crown lengthening using flap + osseous resection method?

Insufficient keratinized gingiva Signup and view all the answers

Which statement about ferrule length is correct?

Ferrule length is crucial for increasing restoration resistance. Signup and view all the answers

What defines the apical one-third of a tooth preparation in relation to restoration?

It provides the greatest retention and resistance. Signup and view all the answers

What is one indicator for selecting orthodontic crown lengthening?

Need to correct excessive gingival display Signup and view all the answers

Which of the following is a benefit of using a ferrule?

It enhances the retention of the restoration. Signup and view all the answers

What condition must be present for flap + osseous resection to be appropriate for crown lengthening?

Keratinized gingiva must be at least 2 mm. Signup and view all the answers

Which factor is NOT involved in assessing the need for crown lengthening?

The patient's age and overall health Signup and view all the answers

A subgingival margin placement has the least impact on the periodontium.

False Signup and view all the answers

A margin should be placed 0.5mm below the gingival crest if the sulcus probes 2.0mm.

False Signup and view all the answers

The parallel profile radiographic technique is a simple and reproducible method to measure biologic width.

True Signup and view all the answers

Equigingival margins are known to retain less plaque than supragingival margins.

False Signup and view all the answers

A biologic width violation is confirmed when the distance from the bone level to the depth of the sulcus is greater than 2mm.

False Signup and view all the answers

Crown lengthening is primarily indicated for improving inadequate tooth structure for restoration.

True Signup and view all the answers

Radiographic evaluation can fully diagnose interproximal violations of biologic width.

False Signup and view all the answers

Surgical crown lengthening is contraindicated if the tooth structure is adequate for restoration.

True Signup and view all the answers

The depth of the sulcus directly affects where the crown margin should be placed in relation to the gingival crest.

True Signup and view all the answers

Gingivectomy is a procedure indicated for shallow sulcus depths of 1.5mm or less.

False Signup and view all the answers

Crown lengthening is primarily performed to address functional concerns rather than esthetic ones.

False Signup and view all the answers

One indication for crown lengthening is the presence of excessive gingival display.

True Signup and view all the answers

The biological width does not play a role in determining whether crown lengthening is needed.

False Signup and view all the answers

Crown margins are typically placed more supragingivally to assist with impression accuracy.

True Signup and view all the answers

Short clinical crowns can lead to difficulties in retention and esthetic concerns, necessitating crown lengthening.

True Signup and view all the answers

Biological width is solely about the depth of the histologic sulcus.

False Signup and view all the answers

Chronic progressive gingival inflammation is a sign of biological width violation.

True Signup and view all the answers

Exposure of subgingival caries is an absolutely contraindicated reason for performing crown lengthening.

False Signup and view all the answers

Crown lengthening procedures only involve surgical methods.

False Signup and view all the answers

Delayed passive eruption can lead to the need for crown lengthening procedures.

True Signup and view all the answers

Crown lengthening is performed only for functional concerns and not for esthetic reasons.

False Signup and view all the answers

Gingivectomy is one of the methods used in crown lengthening procedures.

True Signup and view all the answers

Crown lengthening may be indicated if there is inadequate tooth structure for a restoration.

True Signup and view all the answers

A contraindication for crown lengthening procedures could be the presence of significant gingival recession.

True Signup and view all the answers

The definition of crown lengthening involves increasing the amount of tooth exposed supragingivally.

True Signup and view all the answers

Forced eruption with fiberotomy is not considered a surgical method for crown lengthening.

False Signup and view all the answers

Apically positioned flaps (APF) can be combined with osseous resection in crown lengthening procedures.

True Signup and view all the answers

Aesthetic periodontal corrective procedures do not include interventions for gingival overgrowth.

False Signup and view all the answers

Surgical crown lengthening is only recommended when there are no alternative orthodontic techniques available.

False Signup and view all the answers

Electrosurgery and laser techniques are not applicable to esthetic contouring in periodontal treatments.

False Signup and view all the answers

Gingivectomy is an appropriate method for crown lengthening when there is less than 2 mm of Keratinized gingiva.

False Signup and view all the answers

Crown lengthening can be performed using both surgical and orthodontic methods.

True Signup and view all the answers

The apical one-third of a tooth preparation does not contribute to the retention of a restoration.

False Signup and view all the answers

A contraindication for crown lengthening can include insufficient Keratinized gingiva.

True Signup and view all the answers

Flap + Osseous resection is suitable for crown lengthening when there is more than 2 mm from the CEJ to the alveolar bone crest.

True Signup and view all the answers

Crown lengthening is defined as a procedure to increase the height of the crown on a tooth by removing keratinized tissue.

False Signup and view all the answers

Orthodontic crown lengthening is the only method that can be used for aesthetic reasons.

False Signup and view all the answers

The distance from the cemento-enamel junction (CEJ) to the alveolar bone crest must be at least 2 mm for gingivectomy to be appropriate.

True Signup and view all the answers

The greatest resistance to dislodgement of the restoration is found at the incisal edge of the preparation.

False Signup and view all the answers

Crown lengthening can be performed effectively without any pre-existing conditions concerning Keratinized gingiva.

False Signup and view all the answers

Study Notes

Biological Width

Defined as the distance formed by junctional epithelium and connective tissue attachment on tooth roots.
Typical mean depth of histologic sulcus is approximately 0.69 mm.
Average junctional epithelium depth measures around 0.97 mm, and supraalveolar connective tissue attachment is about 1.07 mm.
Total average biologic width is approximately 2.04 mm.

Biologic Width Violation

Identified through probing under local anesthesia; a measurement of biologic width is obtained by subtracting sulcus depth from the bone level.
A distance of less than 2 mm at any probing site confirms a biologic width violation.
Radiographic evaluation, particularly through bitewing films, can potentially uncover interproximal violations, though limitations exist.

Margin Placement Guidelines

For sulcus depth ≤ 1.5 mm, place margin 0.5 mm below the gingival crest.
For sulcus depth > 1.5 mm, place margin 1-2 mm below the crest depending on specific readings.
If probing indicates > 2.0 mm, perform a gingivectomy and establish a 1.5 mm sulcus before placing the margin.

Types of Margins

Supragingival Margin: Least destructive to periodontium.
Equigingival Margin: Previously thought to retain more plaque but is now regarded similarly to supragingival in periodontal tolerance.
Subgingival Margin: Associated with greatest biologic risk and challenging for hygiene maintenance.

Crown Lengthening

Procedure used to increase exposed tooth structure above the gum line, crucial for retention when there are short clinical crowns or subgingival margins.
Indications include inadequate retention due to extensive caries, unequal gingival levels, and cosmetic concerns from delayed passive eruption.
Methods of crown lengthening vary, including gingivectomy, flap surgery with osseous resection, and apically positioned flaps.

Clinical Considerations

Signs of violation include chronic gingival inflammation, bleeding on probing, localized hyperplasia with minimal bone loss, and gingival recession.
Clinical crown is the visible part of the tooth above the alveolar crest.
A proper ferrule length around the tooth is critical for prosthetic success, minimizing occlusal stress on the periodontal ligament.

Esthetic Procedures

Surgical crown lengthening and forced eruption are employed for inadequate tooth structure.
Grafting techniques, such as free gingival grafts or guided tissue regeneration, address gum recession and overgrowth.
Electrosurgery and lasers are also used for contouring and esthetic enhancements.

Key Figures

Ferrule length must ideally reach 1-2 mm above the preparation's apical third to optimize restoration retention.

Biological Width

Defined as the distance formed by junctional epithelium and connective tissue attachment on tooth roots.
Typical mean depth of histologic sulcus is approximately 0.69 mm.
Average junctional epithelium depth measures around 0.97 mm, and supraalveolar connective tissue attachment is about 1.07 mm.
Total average biologic width is approximately 2.04 mm.

Biologic Width Violation

Identified through probing under local anesthesia; a measurement of biologic width is obtained by subtracting sulcus depth from the bone level.
A distance of less than 2 mm at any probing site confirms a biologic width violation.
Radiographic evaluation, particularly through bitewing films, can potentially uncover interproximal violations, though limitations exist.

Margin Placement Guidelines

For sulcus depth ≤ 1.5 mm, place margin 0.5 mm below the gingival crest.
For sulcus depth > 1.5 mm, place margin 1-2 mm below the crest depending on specific readings.
If probing indicates > 2.0 mm, perform a gingivectomy and establish a 1.5 mm sulcus before placing the margin.

Types of Margins

Supragingival Margin: Least destructive to periodontium.
Equigingival Margin: Previously thought to retain more plaque but is now regarded similarly to supragingival in periodontal tolerance.
Subgingival Margin: Associated with greatest biologic risk and challenging for hygiene maintenance.

Crown Lengthening

Procedure used to increase exposed tooth structure above the gum line, crucial for retention when there are short clinical crowns or subgingival margins.
Indications include inadequate retention due to extensive caries, unequal gingival levels, and cosmetic concerns from delayed passive eruption.
Methods of crown lengthening vary, including gingivectomy, flap surgery with osseous resection, and apically positioned flaps.

Clinical Considerations

Signs of violation include chronic gingival inflammation, bleeding on probing, localized hyperplasia with minimal bone loss, and gingival recession.
Clinical crown is the visible part of the tooth above the alveolar crest.
A proper ferrule length around the tooth is critical for prosthetic success, minimizing occlusal stress on the periodontal ligament.

Esthetic Procedures

Surgical crown lengthening and forced eruption are employed for inadequate tooth structure.
Grafting techniques, such as free gingival grafts or guided tissue regeneration, address gum recession and overgrowth.
Electrosurgery and lasers are also used for contouring and esthetic enhancements.

Key Figures

Ferrule length must ideally reach 1-2 mm above the preparation's apical third to optimize restoration retention.

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Description

Explore the concept of biologic width in dental anatomy and the implications of its violation. This quiz covers probing techniques, radiographic evaluations, and the clinical significance of maintaining biologic width. Test your understanding of these crucial dental principles.