前牙美学之牙龈生物型
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Anterior dental aesthetics: Gingival perspective
Periodontal biotype is classified as thin, normal or thick
Thin periodontal biotype
Thick periodontal biotype
“5 mm rule”
For thick biotypes, the papilla may be established to normal dimensions of 5 mm, but for thin biotypes, it is difficult to recreate a papilla longer than 4 mm from the osseous crest
(d) Thin underlying bone
(d) Thick underlying osseous form
characterized by bony dehiscence (e) Relatively resistant to acute
பைடு நூலகம்
and fenestration
trauma
(e) Reacts to insults and disease (f) Reacts to disease with pocket
Characteristics of thin biotype Characteristics of thick biotype
(a) Highly scalloped soft tissue and (a) Relatively flat soft tissue and
bony architecture
the degree of interproximal fill is also dependant on the periodontal biotype
A thick periodontal biotype encourages interdental fill, while a thinner tissue type creates un-aesthetic hollow gingival embrasures.
The thick biotype with its flattened gingival soft tissue form tends to be more frequent with it occurring in 85% of the population than the thin biotype with its scalloped tissue form (15% of the population).
Secondly, due to the fragility of the thin tissue, delicate management is essential for avoiding recession and hence visibility of subgingivally placed crown margins at the restoration/tooth interface
bony architecture
(b) Delicate friable soft tissue
(b) Dense fibrotic soft tissue
(c) Minimal amount of attached (c) Relatively large amount of
gingiva
attached gingiva
Cause?
High scallop periodontal bioform
Normal scallop periodontal bioform
Low or flat scallop periodontal bioform
With a low scallop, the interproximal bone is thin, and the interproximal gingival contour nearly parallel to the underlying bone contour. The normal is advantageous for implant therapy since the bone has a congruous relationship with the FGM and is less prone to post-surgical recession. With a high scallop, the interproximal bone is wider, but the disparity between the bone contour and the FGM is problematic for favourable aesthetics (due to possible recession and creation of ‘lack triangles’) following implant or restorative procedures.
with gingival recession
formation and infrabony
defectformation
a thin biotype
Firstly, the thin gingival margins allow visibility of a metal substructure.
1. Thin periodontium—thickness of attached gingival less than 1 mm, width—3.5–5 mm, thin marginal bone
2. Thick periodontium—thickness of attached gingival to 1.3 mm, width 5–6 mm and more, thick marginal bone
The 5 mm rule is only applicable for adjacent natural teeth or implants bounded by natural dentition.
Periodontal bioforms are categorised into three basic gingival scallop morphologies
Periodontal biotype is classified as thin, normal or thick
Thin periodontal biotype
Thick periodontal biotype
“5 mm rule”
For thick biotypes, the papilla may be established to normal dimensions of 5 mm, but for thin biotypes, it is difficult to recreate a papilla longer than 4 mm from the osseous crest
(d) Thin underlying bone
(d) Thick underlying osseous form
characterized by bony dehiscence (e) Relatively resistant to acute
பைடு நூலகம்
and fenestration
trauma
(e) Reacts to insults and disease (f) Reacts to disease with pocket
Characteristics of thin biotype Characteristics of thick biotype
(a) Highly scalloped soft tissue and (a) Relatively flat soft tissue and
bony architecture
the degree of interproximal fill is also dependant on the periodontal biotype
A thick periodontal biotype encourages interdental fill, while a thinner tissue type creates un-aesthetic hollow gingival embrasures.
The thick biotype with its flattened gingival soft tissue form tends to be more frequent with it occurring in 85% of the population than the thin biotype with its scalloped tissue form (15% of the population).
Secondly, due to the fragility of the thin tissue, delicate management is essential for avoiding recession and hence visibility of subgingivally placed crown margins at the restoration/tooth interface
bony architecture
(b) Delicate friable soft tissue
(b) Dense fibrotic soft tissue
(c) Minimal amount of attached (c) Relatively large amount of
gingiva
attached gingiva
Cause?
High scallop periodontal bioform
Normal scallop periodontal bioform
Low or flat scallop periodontal bioform
With a low scallop, the interproximal bone is thin, and the interproximal gingival contour nearly parallel to the underlying bone contour. The normal is advantageous for implant therapy since the bone has a congruous relationship with the FGM and is less prone to post-surgical recession. With a high scallop, the interproximal bone is wider, but the disparity between the bone contour and the FGM is problematic for favourable aesthetics (due to possible recession and creation of ‘lack triangles’) following implant or restorative procedures.
with gingival recession
formation and infrabony
defectformation
a thin biotype
Firstly, the thin gingival margins allow visibility of a metal substructure.
1. Thin periodontium—thickness of attached gingival less than 1 mm, width—3.5–5 mm, thin marginal bone
2. Thick periodontium—thickness of attached gingival to 1.3 mm, width 5–6 mm and more, thick marginal bone
The 5 mm rule is only applicable for adjacent natural teeth or implants bounded by natural dentition.
Periodontal bioforms are categorised into three basic gingival scallop morphologies