IATROGENIC FACTORS

What causes periodontal disease

Clinically this information is applied to diagnose biologic width violations when the restorative margin is placed very closed (< 2mm ) from the alveolar bone When the restorative margin is placed too far below the gingival tissue crest, it impinges on the gingival attachment apparatus & creates a violation of biologic width

Two different responses can be observed from the involved tissue: Gingival inflammation Bone loss of an unpredictable nature Gingival recession Correction of biologic width violation: Surgically removing bone away from proximity to the restorative margin Orthodontically extruding the tooth & thus moving the margin away from the bone

Angular bone loss Plaque accumulation Food impaction Plaque accumulation Gingival inflammation, pocket formation Angular bone loss Tooth mobility –tooth loss

INSTRUMENTATION ROUGHNESS AFTER SCALING AND ROOT PLANNING Professional instrumentation of periodontally diseased teeth should lead to complete removal of plaque, calculus & other bacterial component Instrument induced roughness results in Increase surface area Promotion of microbial adherence and colonization Plaque maturation Compromised plaque removal

CONCLUSION Dental restoration play a significant role in maintaining periodontal health. Faults in the part of the dental treatment rendered are common cause of gingival inflammation & often periodontal destruction The adaptation of margin, the contours of the restoration, the proximal relationships, the surface smoothness have a critical biologic impact on gingiva & supporting periodontal tissues

THANK YOU