Biologic Width Demystified
Richard Erickson, MS, DDS
Much fuss is justifiably made by many clinician speakers over violating the biologic width in crown margin placement. We've all seen seminar slides of chronically inflamed tissue around a crown in violation of this sacred region. But what exactly is this so-called biologic width? Why when despite your best efforts to esthetically hide a crown margin in the sulcus, it comes peeking back at you at the next prophy visit? John Kois answered these questions recently1 much more clearly than I have ever heard in a presentation and here are the highlights.
Some healthy dimensions of the gingival area are needed in order to compare to what is abnormal. As you can see on the diagram at left, a kind of symmetry exists in normal healthy gingiva: 1mm sulcular depth, 1mm attached epithelium and 1mm connective tissue before the crest of the bone is reached. This is the biologic width. 85% of healthy patients will exhibit this 3mm dimension, while 2% will be less than 3mm and 13% will be greater than 3mm. Also, the distance between the CEJ and the crest of bone is 2mm on average. When this CEJ to crestal bone distance is less than 2mm, the gingiva ride up the clinical crown making the tooth appear submerged and short. If the CEJ to crestal bone distance is greater than 2mm, the CEJ may be exposed and the tooth will appear too long.
To summarize then, the biologic width is equal to 3mm: 1mm sulcular depth, 1mm attachment epithelium and 1mm connective tissue above the crestal bone. This is true on the broad facial surface. In the proximal papillae area, the correct biologic width increases to 4mm. This can be measured on any tooth using the "sounding" technique.
Aesthetic Enhancement of Pontic Sites for Fixed Partial Dentures
An adequate alveolar bone base is the prerequisite for functional and aesthetically optimal reconstruction of the soft tissue architecture for a fixed partial denture pontic site or dental implant site. If the horizontal and vertical dimensions of the ridge deficiency are within 3 mm of their original contour, acceptable results can he achieved by soft tissue augmentation procedure only, ie, connective tissue grafts, onlay grafts, or an inlay rolled graft. These procedures are usually performed…
Restorative Space Management: Treatment Planning & Clinical Considerations for Insufficient Space
In attempting to provide a restorative solution for cases that have been compromised by spatial considerations, clinicians have traditionally opted for an orthodontic approach that did not provide optimal aesthetics due to changes in tooth morphology, specifically tooth size and shape as a result of dental deterioration. With the advent of contemporary aesthetic materials and preparation techniques, clinicians and technicians are now empowered to deliver a penultimate result with minimal compromise to the surrounding dentition. This article presents the clinical and laboratory considerations that must be addressed when providing a prosthetic restoration for crowded teeth.
Long-Term Outcome of Cemented Versus Screw-Retained Implant-Supported Partial Restorations
The present study was designed to compare the long-term outcome and complications of cemented versus screw-retained implant restorations in partially edentulous patients. The long-term outcome of cemented implant-supported restorations was superior to that of screw-retained restorations, both clinically and biologically.
Comprehensive Esthetic Therapy in a Patient with an Intra-capsular Disorder - Part 2 of 2
Dr. Rob Ritter discusses comprehensive esthetic work-up and treatment planning in the reconstruction of a patient with an existing intra-capsular disorder.
The Interaction of Esthetics and Occlusion In Long Term Success - Part 3
Predictable longevity is achieved by a practical understanding of occlusal principles and a knowledge of how to manage the forces that exist in each individual patient and for the restorations that are envisioned.
Occlusion Simplified - Clinical Techniques for Restoring Anterior Guidance and Opening Vertical Dimension - Part 2 of 3
In this video, learn a practical system for restoring worn teeth, rebuilding anterior guidance, and increasing vertical dimension.
Multidisciplinary Crowns & Bridges
A 5 part course worth 1 CEU.
3-D Smile Designing with a Functional Touch: The Dental GPS Way
In this esthetic driven era, the responsibility of delivering something that is functionally and esthetically acceptable is of utmost importance.
Today , we have something called Dental GPS which is a software that is available both in a clinician version and lab version. It is not only able to help us with the simulation of the proposed results in less than 5 minutes but also able to help us print the diagnostic M lines to help us mount the casts (using a digital facebow) for 2D wax ups and / or 3D virtual wax ups for 3D printed models.
This presentation will highlight the usage, simplicity and precision of planning and execution using the 3D smile design software.
Excellence in Cosmetic Dentistry: Replicating Nature, When Nature Has Been Compromised
Drs. Cherilyn Sheets and Jacinthe Paquett discuss the understanding of the art and science of dentistry to create restorations that duplicate nature.
To view this dental publication or article, you must be a registered user of Dental XP. If you are already a member, click here to login.Registration is free and only takes several minutes. Dental XP will never spam you, or sell your information.