1. IATROGENIC FACTORS

3. What causes periodontal disease

8. 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

9. 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

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

43. 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

47. 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

48. THANK YOU