Gingival papilla. Interdental papillae and problems with them. Symptoms of gum inflammation with photos

Papillitis is an inflammation of the gingival interdental papilla, related to superficial inflammatory periodontal diseases; in a number of literary sources, papillitis is considered as a localized type of gingivitis.

1. Causes of papillitis

The causes of papillitis can be traumatic, infectious or allergic factors. Less commonly, papillitis is a manifestation of endogenous pathology - in diseases of the metabolic system, endocrine pathology, cardiovascular diseases. Determining the immediate cause that led to the development of the disease is necessary to prescribe adequate therapy for the pathology.

2. Classification of papillitis

The basics of the classification of papillitis make it possible to determine the form and nature of the course of the disease, help clarify the diagnosis and adjust the treatment plan for the disease.

According to the variants of the course, acute papillitis and chronic papillitis are distinguished.

According to the form of the disease, acute papillitis can be catarrhal or ulcerative. The forms of chronic papillitis are catarrhal, ulcerative and hypertrophic forms.

With papillitis, the inflammatory process usually involves one or two gingival interdental papillae.

3. Symptoms of papillitis

The symptoms of papillitis depend on the nature of the disease and the clinical form of the pathology. Thus, acute papillitis is characterized by the greatest severity of local inflammatory phenomena - redness, swelling, pain and bleeding of the affected gingival interdental papilla. However, in the chronic course of the disease, all symptoms can be smoothed out, the color of the gums changes to dark red or cyanotic, which reflects the progression of arterial and venous circulation disorders, and pain can appear only during the period of exacerbation of the disease. In addition, the form of papillitis leaves a visible imprint on the clinical picture of the disease.

In the ulcerative form of papillitis, an area of ​​ulceration is observed in the area of ​​the gingival interdental papilla against the background of the above-described local signs of inflammation; in the hypertrophic form, along with the picture of inflammation, there is a “proliferation” of tissue in the form of granulomas or fibromas, which requires differential diagnosis with other diseases. In some cases, to clarify the diagnosis, histological examination is necessary. Histological analysis describes the appearance characteristic of the hypertrophic form of papillitis - gum mucosa with proliferation of cells of the basal layer, against the background of proliferation of the fibrous connective base and blood filling of the capillaries, sometimes individual cells with elements of parakeratosis are identified. As a rule, the diagnostic algorithm also uses x-ray examination, which often reveals osteoporosis of the interdental septa. In the chronic course of the disease, resorption of the apex of the septum and partial destruction of the compact lamina at the apex are often detected. During probing with instruments, no abnormal pathological pockets in the gums are detected.

4. Treatment of papillitis

Before prescribing therapy for papillitis, the causative factors of its occurrence are determined in each individual case. Due to the variety of etiological factors of papillitis, the tactics of dental care require strict individualization.

Treatment of papillitis of traumatic etiology is carried out comprehensively. After carrying out antibacterial, anti-inflammatory therapy and relieving the severity of the inflammatory process, methods aimed at eliminating the traumatic factor can be used in the treatment of papillitis. Thus, in case of pathological position of the tooth, the presence of its crowding, various orthopedic methods of influence are used, including for young patients (up to 30 years) and the insignificance of the required restructuring - orthodontic treatment. In case of papillitis, which is the result of an acute injury to the gingival papilla, after the severity of the inflammatory phenomena has been relieved, it is recommended to use indirect methods of restoration - cast inlays or crowns for more accurate restoration of contacts between teeth.

Treatment of papillitis, which forms as a result of the traumatic impact of a defective crown, begins with the removal of this crown and the (later) administration of drug therapy aimed at relieving inflammatory phenomena. In such cases, during repeated prosthetics, the quality of tooth processing is assessed and defects in tooth preparation for a crown are corrected.

In case of the infectious nature of the disease, which develops as a complication of the cervical caries process, treatment is carried out from the standpoint of the treatment of dental caries, with the parallel use of anti-inflammatory therapy.

Treatment of papillitis of allergic etiology inherently includes the administration of antiallergic drugs. - you can find out here.

In rare cases, with pronounced chronic hypertrophic papillitis in the “cold period,” local surgical options are possible aimed at removing excess tissue growth.

Pain, bleeding and inflammation of the oral mucosa in adults can cause no less inconvenience than toothache. In addition to discomfort, this condition without timely and proper treatment can lead to the loss of a tooth, or even several. Why does severe and persistent inflammation occur? - Possibly as a result of injuries to the teeth or mucous membranes. If gum inflammation does not go away on its own for a long time, you need to visit a dentist. If pathological changes occur in the condition of the gums, it is necessary to urgently seek advice from a periodontist.

Why gums can become inflamed: an overview of the reasons

The doctor determines the factors causing changes in the interdental papillae and gums and, based on the examination results, prescribes the necessary treatment. Very often, redness and swelling of the gums can be caused by improper dental and oral care. Immunity plays an important role in protecting the body; when its level is low, even a minor injury can become the root cause of inflammation. Many factors can trigger gum inflammation, for example:

1. trauma to teeth and gums;
2. chronic diseases of the cardiovascular system, diabetes mellitus, diseases of the gastrointestinal tract;
3. the hereditary factor is directly related to the appearance of inflammatory processes in the body;
4. presence of bad habits;
5. hormonal disorders;
6. Improperly organized dental and oral care can create problems;
7. Treatment of inflammation is also carried out if an unsuitable crown or poor-quality filling has been installed.

Pathological changes in the gums are affected by the appearance of tartar. Accumulating near the tooth, it begins to put pressure on the soft tissues, injuring the mucous membrane. Over time, the problem worsens: inflammation of the gums around the tooth is accompanied by the appearance of a kind of pocket in which food debris accumulates (we recommend reading: methods for treating inflammation of the gums around the tooth). As a result, suppuration of the gum tissue and peri-gingival pocket, and swelling of the interdental papilla may occur. The causes of gum pathologies are often gingivitis and periodontitis. Gingivitis is an inflammation of the mucous membrane and area of ​​the neck of the tooth (gingival margin).

Symptoms of gum inflammation with photos

It is necessary to understand that a disease in an advanced stage is much more difficult to treat and takes longer. To avoid these troubles, you need to make an appointment with a specialist when the first signs of the disease appear. Symptoms:

• the appearance of painful sensations while brushing your teeth;
• the occurrence of bleeding, the formation of pus in the gum pockets;
• swelling of the interdental papillae and marginal gums, looseness of the gingival tissue;
• change in gum color during the transition from acute to chronic form (interdental peri-gingival papillae acquire a bluish tint);
• the upper swollen gum hurts and causes discomfort while eating;
• an unpleasant, putrid odor appears from the mouth (we recommend reading: why can a putrid odor appear from the mouth of a child?);
• tissues of the interdental peri-gingival papillae grow;
• the oral mucosa begins to react painfully to the temperature of food and drink;
• Increased tooth sensitivity develops due to the lowering of the gum edge and exposure of the neck of the tooth.

Symptoms of tissue inflammation can be seen in the photo. In cases where the mucous membrane and interdental peri-gingival papillae are inflamed, this may be the beginning of the development of periodontitis.

Effective medications for inflammation

What medications may be needed to relieve symptoms resulting from injury or severe gum inflammation? In order for therapy to produce positive results, it is first necessary to eliminate the cause of the disease. In the dentist's office, using ultrasound, it is necessary to carry out professional cleaning and remove bacterial plaque.

After this, a course of treatment with anti-inflammatory drugs is prescribed. The fight against the disease must be comprehensive: it is necessary to take antibiotics as prescribed by the doctor, and use medicated toothpaste for daily hygiene procedures. In addition to these measures, you may need to use special rinses against sore gums and swelling of the gingival papillae.

Anti-inflammatory ointments and gels

The use of anti-inflammatory ointments in dentistry for diseases of the oral cavity gives very good results. Preparations in the form of ointments in a short time are capable of:

1. relieve pain and eliminate itching;
2. get rid of bleeding;
3. remove redness.

Gels used in the treatment of gum tissue diseases are more effective. Due to their properties, after application they form a film on the surface that can have an effect on the inflamed area for a long time.

Toothpastes

1. cleanses soft plaque formed during the day;
2. help reduce inflammation and swelling;
3. help eliminate tartar;
4. have a healing effect;
5. reduce bleeding and irritation.

Such effective pastes as Forest Balsam, Paradontax, Lakalut active, President have proven themselves well. In addition to using toothpastes, massaging the gums with a soft toothbrush can be an excellent means of prevention. Prevention to eliminate gum disease is no less important than timely therapy.

Antibiotics

Antibiotic therapy is used in the most serious and advanced cases. When severe inflammation occurs, serious intoxication of the body develops. Medicines not only eliminate the signs of the disease, but also help restore the functions of all systems. The use of antibiotics should be agreed with the attending physician, who will select the required dose of the drug and draw up a treatment plan. Medicines are available in the form of tablets, capsules, and rinsing solutions.

Rinse with pharmaceutical products

Effective antiseptics such as Miramistin and are prescribed for mouth rinses. The best pharmaceutical remedy for inflammation is Miramistin. It has a disinfecting and anti-inflammatory effect on diseased, affected gums and periodontal gingival papillae. In some cases, rinsing with a solution of hydrogen peroxide is prescribed. It must be remembered that all medications should be used only as prescribed by a doctor.

Traditional recipes for inflammation and redness of gums

Treatment at home involves the use of folk remedies that will help with gum inflammation. Gingivitis can be cured at home - medicines made according to traditional medicine recipes can relieve swelling, and when the gums itch and ache, they will have a calming effect. Natural preparations are prepared in the form of decoctions for rinsing or infusions for internal use.

• They use calendula, birch buds, chamomile, celandine, and sage.
• In addition to herbs, bee products are often used to prepare medicines: beebread, propolis, honey.
• When the gums become inflamed and very painful, and the periodontal papillae swell, salt treatment can help.
• Treatment of inflamed gums with salt is carried out as follows: add one teaspoon of salt to a glass of water at room temperature and mix well. Rinsing with this solution helps a lot when the gums, gingival pocket and periodontal papillae are a little red.

Despite the fact that all products are natural, some herbs contain toxic substances in varying proportions. Treatment with folk remedies should be carried out under the strict supervision of a doctor.

Principles of treatment for diseases of the oral cavity

Self-medication in the event of inflammatory processes in the oral cavity may not be effective. All specific prescriptions can only be carried out by a specialist who will eliminate the symptoms and help get rid of the cause of the disease. The doctor, if necessary, will prescribe examinations and laboratory tests. Redness, swelling of the gums and interdental peri-gingival papillae are signs of gingivitis. Prevention of inflammation of the upper and lower gums always gives good results, so do not forget about it.

Gingivitis

In cases where the mucous membrane is inflamed and pus has formed in the gum pockets, a suspicion of gingivitis arises. In case of gingivitis, soft plaque is cleaned and hard plaque is removed using ultrasound. After this, a comprehensive treatment is prescribed aimed at reducing tissue swelling, eliminating bleeding and relieving pain. When gingivitis develops, the gums become inflamed and swell (only the superficial layers of tissue are affected) - the treatment prognosis is positive, provided that the specialist’s recommendations are strictly followed.

Periodontitis

Periodontitis is a more serious form of the disease. With a long-term pathological process, the gingival periodontal papillae can atrophy along with the mucosal area. Periodontitis therapy is carried out according to the following plan:

Dental manipulations

If a cyst or fistula has formed in the gum tissue, surgical intervention may be required. After anesthesia, the surgeon makes an incision, removes the affected piece of periosteum and removes pus from the resulting cavity. Then the wound is washed and temporary drainage is installed.

When restoring the dentition, if the gingival periodontal papillae have partially atrophied, surgical intervention is resorted to. The specialist forms the gingival periodontal papillae using implants followed by a course of phonophoresis.

Wisdom tooth eruption

Sometimes inflammation develops due to the eruption of wisdom teeth. Symptoms are: severe redness and inflammation, gums hurt and ache, tissue swelling appears at the end of the dentition. Based on the X-ray examination, the specialist makes a decision either to remove the tooth or to prescribe conservative treatment.

In case of inflammation, rinses with antiseptic solutions are prescribed, and in order to eliminate pain, analgesic-based products are used.

How to quickly relieve inflammation?

In order to quickly eliminate soreness and inflammation of the gums, you can use a solution of salt and soda for rinsing. Red rowan juice has excellent healing properties. Decoctions made from herbs are good for gum inflammation. Take two tablespoons of dried raw materials per glass of boiling water, after which the broth must be allowed to brew for ten minutes. The optimal temperature of the rinsing solution is about 35-40 degrees.

Doctor of Dentistry, private practice (periodontics and prosthetic dentistry) (Leon, Spain)

Doctor of Dentistry, private practice (periodontology) (Pontevedra, Spain); Associate Professor at the University of Santiago de Compostela

In order for the restoration to look natural and the restored teeth to perform their function correctly, it is necessary to take into account the structure of the gums, the appearance of the lips and the patient’s face as a whole. Mucogingival surgery is available to treat gum recession.

Interdental gingival papilla- This is the area of ​​gum between two adjacent teeth. It not only serves as a biological barrier that protects periodontal structures, but also plays a significant role in the formation of the aesthetic appearance. The absence of interdental gingival papillae can lead to problems with pronunciation, as well as the retention of food debris in the interdental spaces.

If the interdental gingival papilla is lost, its regeneration is quite difficult. Only a few such cases are known in dental practice. However, none of the reports contain information about methods that can restore the gingival papilla. This report describes a surgical method for restoring mucosa and gingival papilla in the pontic pontic area in the presence of bone deficiency.

Surgical technique

The patient, 45 years old, came to the clinic for treatment of periodontal pathology. She complained about the mobility of the two upper central incisors. The patient wanted to restore her appearance and also eliminate periodontal pathology. The central incisors had mobility of the 3rd degree, the depth of the pockets during probing was 10 mm and 8 mm. In the area of ​​the right lateral incisor, a periodontal pocket with a depth of 10 mm was also found in combination with a vertical bone defect, which indicated a deficiency of bone tissue under the gingival papilla (Fig. 1 a, b).

Rice. 1a. Recession found on the labial side of teeth 11 and 12

Rice. 1b. Recession found on the labial side of teeth 11 and 12

A 7 mm deep pocket was also found in the area of ​​tooth 22.

When collecting anamnesis, no allergies, concomitant diseases or bad habits were revealed. The patient was classified as ASA class 1. Several weeks before surgery, the patient was taught oral hygiene, in addition, subgingival deposits were removed and root surfaces were cleaned. After removal of granulation tissue in the area of ​​the gingival papilla in the area of ​​the 12th tooth, soft tissue recession to a height of 3 mm was discovered. In accordance with Miller's classification, she was assigned class III. On the vestibular side, in the area of ​​teeth 11 and 12, soft tissue recession to a height of 2 mm was also detected (Fig. 2).

Rice. 2. Vertical defect and class III mobility of teeth 11 and 21

Due to the loss of bone around the two central incisors, the decision was made to remove them (Fig. 3).

Rice. 3 a - d. The first large connective tissue graft was used in the area of ​​the intermediate part of the bridge to protect the interincisal gingival papilla. We made sure that the temporary prosthesis does not put undue pressure on the graft

When smiling, the patient's gums were partially exposed (no more than a third of the length of the coronal part). At the same time, the color of the gum mucosa was heterogeneous. Photographs, x-rays were taken, alginate impressions were taken and masticography was performed. Based on digital analysis of photographs, diagnostic models were made, which were then placed in the articulator. The patient was then given treatment options. A tooth-supported bridge represents the most current option for replacing missing teeth, especially as an alternative to complex vertical guided bone regeneration, which would require frequent examinations and strict patient compliance. The use of such a prosthesis is less risky than installing an implant-fixed prosthesis if bone and soft tissue are not present in sufficient quantities. The patient had a high sociocultural level and aesthetic preferences. Taking into account other personal factors, in particular the patient’s place of residence, we were forced to choose the fastest, most effective and reliable solution. During her first three visits to the hygienist, the patient cried. Given her emotional instability, we abandoned a comprehensive therapeutic approach to reduce the risk of psychological trauma and possible failure. After the existing problem was explained to the patient, she agreed to remove two central incisors, correct the gums in the area of ​​the intermediate part of the bridge, as well as the gingival papilla using several connective tissue grafts. On the same day, after appropriate preparation of the canines and lateral incisors, a temporary fixed prosthesis was installed. The neck of tooth 12 was prepared accordingly, taking into account the likely future soft tissue reconstruction. Endodontic treatment of the lateral incisors was required. Silicone impressions were made to create a second, more accurate, long-lasting temporary prosthesis and to re-evaluate the case from a biological, functional, and esthetic perspective. Four weeks later, soft tissue recession was detected due to bone resorption on the vestibular side of the maxillary alveolar process.

First, a large connective tissue graft was used (Fig. 4).

Rice. 4 a - d. After the second stage of surgery, the volume of tissue in the area of ​​the right central incisor and the papilla between it and the lateral incisor was increased

Using several soft tissue incisions, a tunnel was created in the area of ​​the pontic pontic (Fig. 4). A 6-0 nylon suture was used to secure the graft. We ensured that the temporary prosthesis did not place undue pressure on the graft (Fig. 4). Then we took a break for 4 months. At the end of the period, an increase in the volume of soft tissues was revealed, which still remained insufficient (Fig. 5).

Rice. 5 a - d. The connective tissue graft was installed using a tunnel approach after frenectomy

We needed more tissue in the area of ​​the right central incisor and the gingival papilla between teeth 11 and 12. The depth of the pocket during probing is 7 mm (Fig. 5). Given the loss of 3-4 mm of papilla tissue, we can conclude that the probable probing depth was 10 mm with a 5 mm bone defect at the level of the papilla. After this, the second phase of surgery began (Fig. 5). The preoperative status of the interdental gingival papilla was determined using the Norland and Tarnow classification. The interdental gingival papilla, vestibular and palatal gingiva were numbed with local anesthesia using 1 capsule of Ultracaine® (articaine HCl/epinephrine, 40/0.005 mg/ml) and 1:100,000 epinephrine solution. For better visualization of the surgical field, a surgical dissecting loupe was used. First, a semicircular incision was made at the mucogingival junction to reposition the labial frenulum (Fig. 6).

Rice. 6 a - d. A diamond cutter was used to remove part of the transplanted epithelium

The second incision was made with a microscalpel from the lost gingival papilla along the gingival sulcus around the neck of the lateral incisor. The blade was turned towards the bone. The incision was made through the entire thickness of the gum tissue and provided access for a mini-curette. The third incision was made along the apical border of the semicircular incision directly in the direction of the bone (Fig. 6). As a result, a gingival-papillary complex was formed. Its mobility was necessary to create free space under the gingival papilla and install a connective tissue graft. In addition, some mobility of the palate tissue was also ensured. The resulting flap was fixed coronally using a curette directed along the gingival sulcus and a small periotome. The amount of donor tissue required was determined during a preoperative assessment of gingival and incisal height in comparison with the expected new location of the gingival papilla. A section of connective tissue of significant size and thickness with a section of epithelium 2 mm wide was taken from the patient’s palate (Fig. 5). An area of ​​epithelium was taken to obtain denser and more fibrous connective tissue, as well as to better fill the space under the coronally fixed tissue flap. The use of a large volume of tissue increased the chances of successful graft engraftment, since the graft was nourished by blood perfusion from a larger area. An area of ​​epithelium was placed on the buccal side of the coronally fixed tissue flap, but was not covered by it (Fig. 6), since epithelium is denser than connective tissue and therefore better suited as a base for the repositioned flap. The connective tissue portion of the graft was placed in the gingival sulcus of the lost gingival papilla to prevent movement of the tissue flap and retraction of the papilla (Fig. 6). A 6-0 nylon suture (interrupted suture) was used to secure the graft in position and stabilize the wound. This microsurgical approach was made possible by using a Zeiss optical microscope. The wound on the palate is closed with a continuous suture. The patient is prescribed amoxicillin (500 mg, three times a day, 10 days), as well as an alcohol-free mouthwash with chlorhexidine (twice a day, 3 weeks). Keratinizing epithelial cells and food debris could be removed from the wound surface using a cotton swab soaked in chlorhexidine gluconate. After 4 weeks, the stitches were removed. The patient was also prohibited from using mechanical means to clean teeth in the wound area for 4 weeks. An earlier examination of the patient was impossible due to the remoteness of her place of residence. The postoperative period passed without complications. The third stage of surgery took place before installation of the permanent prosthesis. Using a diamond cutter, part of the transplanted epithelium was removed (Fig. 7).

Rice. 7 a - c. Transformation of the intermediate part of the bridge after the first and second operations

The area between the pontic and the lateral incisors was not probed for 6 months. As a result of probing, a gingival pocket with a depth of 5 mm was discovered in the area of ​​the lateral incisor, which was only 1 mm greater than the depth of the gingival pocket in the area of ​​tooth 22.

results

The patient's condition was assessed 3 months after the first surgical procedure. Only horizontal tissue growth was achieved in the pontic pontic area (Fig. 8).

Rice. 8 a, b. After the second stage of surgical intervention, the edge of the soft tissue of the gingival papilla was 3-4 mm closer to the incisors than before the operation, while there was no bleeding, and probing did not give negative results

The depth of probing in the area of ​​the lateral incisor before the second operation was 7 mm. A recession of 3 mm in diameter was found in the area of ​​the right lateral incisor (Miller class III). After the second stage of surgical intervention, the edge of the gingival papilla was 3-4 mm closer to the incisors than before the operation. The depth during probing decreased by 4-5 mm. An examination carried out after 2 years showed that the clinical results recorded 3 months after surgery had improved. In particular, there was no black triangle between the artificial crowns of the lateral and central incisor (Fig. 9 a, b).

Rice. 9 a. When checked after two years, no black triangle was found between the lateral and central incisors

Rice. 9 b. When checked after two years, no black triangle was found between the lateral and central incisors

There was no retraction or compression of the papillary tissue, and the probing depth did not increase. Radiographic examination showed improvement in the condition of the underlying bone (Fig. 10).

Rice. 10 a - d. Radiographic examination showed significant improvement in the condition of the underlying bone, although no bone graft was used

The depth of the gingival groove of the papilla is greater than on the opposite side, there is no bleeding, and probing does not give negative results. The success of the procedure depended on the following factors:

• The space between the bone and the coronally fixed gingival papilla was filled with a connective tissue graft.
• The connective tissue was well stabilized by the suture.

conclusions

In clinical cases that present not only a medical but also an aesthetic problem, reconstructive surgery can mask tissue loss, but the patient rarely achieves an ideal appearance. To improve the results of such intervention, periodontal plastic procedures can be used. The use of optics and microsurgical instruments is recommended. This allows the surgeon to improve visibility, avoid unnecessary incisions, and increase the chances of a favorable treatment outcome.

Concept awareness biological width– a sign of the evolution of the orthopedist. At every seminar, at every meeting, doctors are tormented by the same questions - “how to sharpen correctly? up to the gum or below? where should I hide the edge of the crown?” The answer to these interrelated questions is given by knowledge of the sizes and types of tissues surrounding the tooth or implant.

The main components that form biological width are shown schematically

Biowidth is formed by connective tissue attachment ( otherwise called "circular ligament"), epithelial attachment ( actually the “bottom” of the periodontal groove) and thickness of the mucous membrane ( which forms the dental-gingival groove or groove). The total biological width is 3 mm.

If you prepare a tooth to the gingival contour and carry out standard retraction with a thread, you will notice a certain reserve of subgingival space, which is mistakenly used by orthopedists to place the edge of the preparation. The error becomes noticeable already when taking an impression - the corrective mass does not get into the space behind the shoulder - there is simply no room for it. Therefore, during retraction, the visually identifiable shoulder may undergo rigorous polishing and leveling.

If you fold back the flap and check the value of the biological width, it will be equal to 3 mm.

So, there are 3 main types of observed preparation levels:

• gingival level (allowing high-quality polishing of the ledge to facilitate the preparation of the edge of the restoration, taking an impression and performing fixation according to any protocol)
• subgingival level (those “half a millimeter under the gum”, which make it difficult to remove the impression, and therefore the “readability” of the impression by a dental technician, make it difficult to fix using the adhesive protocol due to injury to the gums by the rubber dam clamp)
• deep subgingival level (actual preparation error or work dictated by circumstances of non-contact with the patient)

At the gingival level of preparation, manual polishing of the shoulder or polishing of the connection line between the root and the crown becomes possible.

The interproximal area of ​​preparation is also regulated during preparation by the values ​​of the biological width to create adequate interdental papillae that are not inflamed when wearing an indirect restoration. Providing a “bypass” of the gingival papilla can be done by installing a wedge at the time of tooth preparation. When preparing a tooth, the position of the contact point must be taken into account and indicated to the dental technician. In fact, if we have a distance from the preparation line to the bone part of 3 mm, then according to the Tarnow relationship, the contact point should be located within 1.5-2.5 mm from the ledge line.

Otherwise, the gingival papilla will not occupy the entire contact point, forming a “black triangle”, so disliked by orthopedists. By adjusting the position of the contact point to the dental technician, we protect ourselves from problems with the papillae in 100% of cases.

However, the health of the gingival papilla is primarily based on the fact that it must be supported by the root of the tooth, and not by the crown. In this photo, a metal-free crown is installed on a tooth, with the help of which we determined the distance from the ledge line to the bone part by folding back the flap. The absence of immersion “by half a millimeter” does not in any way affect the aesthetic appearance of the crown.

Many doctors appeal to the fact that their patients cannot afford metal-free crowns and they are “forced” to work with standard metal-ceramic crowns. Taking this into account and in order to “hide the transition of the edge of the crown into the tooth,” they prepare below the gingival contour. Since the postulates of biological width work not only on cosmetic types of crowns, but on all types in general, the placement of the ledge level will be the same.

In order for the work to look aesthetically pleasing, the exact edge of the preparation line is important - the rest can be decided.

Even without a ceramic shoulder...

Metal-ceramic crowns in the anterior segment on the day of installation. The gingival contour looks good even after controlled cleaning of the post-marginal area from cement residues.

Biological width should also be a leading factor when planning orthopedic work.

When correcting the zenith level, the ledge preparation line is formed by retreating 3 mm from the new (corrected) level of the alveolar part.

During surgical lengthening, it is very convenient to mark the preparation line.

And carry out the final preparation 8 weeks after surgery.

Removing the behind-the-stage area is a prerequisite for quality work. If, after retraction, we still immerse the line of the ledge into the vacated space, the behind-the-ledge zone in the impression will be imprinted to a lesser extent. Therefore, after retraction, polishing is strict.

The retraction area and the penetration of the base and corrective mass into this area are clearly visible on the underlay.

The epithelial attachment and thickness of the mucous membrane precisely regulates the position of the ledge line for each specific tooth being prepared. Therefore, a periodontal probe is an integral attribute of the work of not only a periodontist, but also a good orthopedist.

The quality of the imprinted post-abrasive zone allows the dental technician to solve the problem of the aesthetic appearance of the crown edge as efficiently and beautifully as possible.

In addition to your own teeth, you need to maintain the proportions of the biological width and around the implants. There is a significant difference between these two types of meanings. First of all, it is worth considering that the collagen fibers that form the connective tissue attachment to your own tooth have a transverse direction, and in the tissues surrounding the neck of the implant or abutment, it is strictly longitudinal. Therefore, the difference in values ​​is 1 mm. The biological width of the implant is 4 mm.

A standard healing abutment with a height of 7 mm is installed.

Emergency profile

A small disadvantage of A-silicones will be demonstrated here. The fact is that when working with implants, polyester impression compounds are preferable - they have greater fluidity and do not displace the gingival profile apically. A-silicones (and even more so C-silicones) imperceptibly deform the gingival contour, the consequences of which you will see further.

The biological width of the tissues surrounding the implant is 4 mm.

Individual zirconia abutment with a neck height of 4 mm.

A standard metal-ceramic crown without any shoulder.

Abutment installed

A metal-ceramic crown was installed. The “revenge of A-silicone” is clearly visible here. More elastic than polyester, A-silicone causes creasing of the thin edge of the gum. Therefore, when working with A-silicone, indicate to the dental technician the necessary adjustment for the placement of the abutment shoulder: for a thick biotype, 0.5 mm, and for a thin biotype, 1 mm.

Common problem: Loss of gingival papillae and the appearance of “black triangles”.

Loss of gingival papillae, especially in the anterior maxilla, is a serious aesthetic problem and can cause significant psychological discomfort in patients with a high smile line.

The World Health Organization defines health as physical and psychological well-being. Therefore, dentists should strive to improve the patient’s appearance when restoring teeth (bridges, veneers, composite restorations) and gum correction. In other words, the goal of dental care is to ensure the physical and psychological well-being of the patient by optimizing the aesthetics of the teeth and gums.

Due to the prevalence of loss of interdental papillae and the aesthetic defects associated with this condition, there is a need to solve this problem (Fig. 4-3a and 4-3b).

Effective solution: Measuring biological width using bone probing.

In 1961, Gargiulo et al published the results of measurements of the depth of the periodontal sulcus, epithelial and connective tissue attachment, i.e. biological width (Fig. 4-3c). It is known that violation of the biological width leads to the development of gingivitis and periodontitis, even with careful oral hygiene (Fig. 4-3d). Tarnow et al." revealed an inverse relationship between the probability of filling the interdental space with the gingival papilla and the distance between the interdental contact and the alveolar ridge (Fig. 4-3).

In the past, dentists paid attention to the location of the contact point solely for reasons of preventing food from entering the

Rice. 4-Pros. A forced smile does not bring satisfaction to the patient. There are “black triangles” between the teeth

Rice. 4-ЗБ. Patient's smile line

Rice. 4-3d. When carrying out treatment, the biological width was not taken into account, which led to the development of gingivitis, despite careful hygiene

Rice. 4-Ze. The probability of the gingival papilla filling the interdental space depending on the distance between the contact point and the bone edge (Tarnow et al.

interdental space and, taking this circumstance into account, prosthetics were performed, including the anterior group of teeth (Fig. 4-3f and 4-H). The coronal boundary of the interdental contact is determined by aesthetic criteria, and the apical boundary depends on the distance to the alveolar bone (Fig. 4-3h).

In an article devoted to the features of the dentogingival complex, Kois

described the use of periodontal parameters in prosthetic treatment planning and a method for determining the contour of the alveolar ridge margin. It was this author who first demonstrated the feasibility of probing the bone before prosthetics.

After local anesthesia has been administered, the periodontal probe is inserted until it makes contact with the bone (Fig. 4-3i.

Rice. 4-3f. Symmetrical arrangement of contact points in the anterior part of the upper dentition.

and 4-3j), the obtained values ​​are documented in the patient’s chart (Fig. 4-3k). In the future, these data can be used to create a composite restoration, orthodontic movement of teeth and the manufacture of prosthetics, such as veneers and crowns (Fig. 4-31 and 4-3).

Without a thorough analysis of the parameters of the dentogingival complex, it is impossible to achieve predictable regeneration of the gingival papillae (Fig. 4-3p).

The application of the technique described above and the use of the obtained data when performing prosthetics allows us to obtain a satisfactory result (Fig. 4-3).

Rice. 4-Zd. Wax-up of upper anterior teeth (Kubein-Meesenberg et al.

). Localization of contact points is determined using interproximal cones

Rice. 4-3h. The relationship between the apical border of the interdental contact point and the level of the alveolar ridge (Tarnow et al.

Rice. 4-3j. Probing the bone crest

Rice. 4-3i. Measuring the size of the gingival papilla and the distance between the bone level and the contact point

Rice. 4-Zk. Documenting indicators in a special form