Characteristics of fixed prostheses.

Fixed restorations can have different characteristics depending on the type of work.
that it is done.

They are generally characterized by showing carvings or wear on the dental surfaces, for
provide these with the respective qualities for their better performance in the oral cavity, both
functional as aesthetics.

Characteristics of cervical termination lines.

Dental preparations end in a finishing line. Some end over the

occlusal and axial surfaces, and are known as cavo-superficial angles. However, the
the more controversial are the gingival finishing lines.

The increased use of full-coverage restorations, and the emphasis placed on the
periodontal support, are responsible for the rejection of the traditional extension of the margins
coronary within the subgingival space. The previous recommendation was to extend the
margins within the intracrevicular space because the gingival crevice was made intentionally
to be immune to cavities.

The deviation or departure from this norm was considered irresponsibility, despite the
The fact that there was strong evidence supporting or justifying the supragingival margins.
On the contrary, subgingival margins are considered necessary for the reasons that
we indicate the following:

Aesthetics
Presence of existing restorations that extend into the space
intracrevicular
Insufficient vertical length for retention

A frequently omitted precept is the soft tissue close to the tooth, generally not
it is healthy before preparation. The original contours that support the soft tissue have been
affected by caries or have been modified by existing restorations. Therefore, a
the rational approach to treatment consists of the removal of tissue with questionable architecture
allowing a healthy tissue to grow again.

A careful analysis of the generalities about where they should be placed is required.
finishing lines for an optimal contour. The subgingival area is not an immune area.
Additionally, if the theory of passive eruption has any validity, the subgingival margin must
to become supragingival in a surprisingly short period of time. Therefore, the evaluation of
The dentist must delve into the longevity or duration of the restoration.

There are four basic types of finishing lines: shoulder, bevel, chamfer, and knife edge.
There are four fundamental criteria for margins to be successful:

- Acceptable marginal adaptation

- Tolerant tissue surfaces
- Adequate contour
- Sufficient force.
Types of cervical margins.

The most critical part of a complete or partial crown is the margin. Its fit depends on
greatly affects the success or failure of the fixed prosthesis. For this reason, in the preparations
Prosthetic, we will pay special attention to the design and realization of the contour or margin.
of the same.

The shape of this margin depends on the material we are going to use for construction.
of the prosthesis.

The adjustment of the margins depends on the bezels, this is based on the following principle: When
two parallel surfaces separate at the same time in a certain direction, the separations
they accuse more in the part that is perpendicular to the direction of movement. Taking as a basis
this principle allows us to compensate for the small contractions of the materials, so that we
transmit at least on the margins.

In the prosthetic preparation of the tooth, we can choose any type of margins or contour;
but the material used in the construction of this prosthesis must have a resistance that
allow this margin.

PROSTHETIC ERRORS AFFECTING THE PERIODONTIUM

Placement of prostheses in periodontally active patients.

The first unbreakable rule before a restorative treatment must be to control

inflammation (gingivitis or periodontitis) before, during, and after it. Most of the
periodontal patients have lost a dental piece that requires treatment
prosthetic to restore it. Teamwork: periodontics, prosthodontics, orthodontics, etc.
Coordinated in its sequence is essential for good rehabilitation.

Initial phase: Oral hygiene instructions, scaling and root planing, caries control,
extractions, endodontics, and removal of iatrogenic prostheses
Provisional restorations and stabilization (splinting)
Definitive periodontal treatment: bone and mucogingival surgery if necessary
Prosthetic phase: once established, after periodontal surgery or crown lengthening, the sulcus
definitive gingiva margins are repositioned. The definitive prosthesis should be delayed as much as the
Gingival margin requires stabilization as recession or creeping attachment may occur.
changing the final periodontal and aesthetic results: Gibson, wait 4 months; Wise, 5 months;
6 months

Maintenance phase, essential for maintaining periodontal health.

Invasion of biological space.

The invasion of biological space occurs very frequently and the primary cause of this is the
lack of awareness of the dimensions of this space and of the great importance at the periodontal level
What their invasion has. The most important thing to keep in mind when it comes to subgingival margins.
it is the location of the base of the gingival sulcus or periodontal pocket (to know the anatomy of the
dento-gingival union.

All these values are 'an average' among large intervals where the connective insertion has
the most stable and least variable dimensions (Vacek 1994).

We must take into account that the gingival sulcus is not a statistical value but rather it needs to
to probe each dental surface. It should not be forgotten that probing is not very reliable and that the
the probe penetration may vary depending on the force used, level of gingival inflammation and
localization of the tooth. Regarding the measurements of the biological space, they vary among individuals and
even in the same tooth. There are authors who prefer to work with the entirety of the dento-
gingival (probing from the gingival margin to the bony crest) claiming that the probing is not reliable and
The components of the dentogingival union are variable.

The dentogingival junction at the buccal level is 3 mm, at the interproximal level it is 4.5 mm as it depends
of the festooning of the interproximal alveolar bone that is parallel to the amelo-cemental junction
circumferentially. This scalloping is greater anteriorly and flattens posteriorly. It has
to prepare the margin taking into account this scalloping that also follows the biological space.
Thus, I conclude that the biological space is a histological entity with variable dimensions and
clinically undeterminable and that a healthy and stable gingival margin is the best reference to
time to perform fixed prosthesis.

Situations where we can provoke a biological space invasion:

- During the carving

- During gingival retraction. What is the ideal method of gingival retraction?
Mechanical-chemical or surgical methods.
- During the impression takes
- During the cementation of the restorations
- Overextended restorations

The invasion of biological space produces the following clinical manifestations:

Poor plate control by the patient

Marginal gingival inflammation (hyperplasia)
Reabsorption of the alveolar bone (iatrogenic periodontitis)
- Fine periodontium (oral): Recession (the invasion self-corrects but does not)
predictably
- Thick periodontium (interproximal): Chronic gingival inflammation, defects
infrasonic

Fortunately, not every time a biological space invasion occurs are all offered.
these side effects, in addition to the iatrogenic restoration, must be remembered that
there are other factors of initiation and progression of periodontal disease such as the
virulence of the plaque and the susceptibility of the host necessary to produce periodontitis. The
Dental preparation represents a reversible trauma to the sulcular epithelium and connective tissue.
as long as the environmental conditions are favorable, producing a new epithelium
in 7-14 days.

Precision of the prosthetic margin

The prosthetic margin must extend precisely with the natural tooth. If that does not happen and
there is a poor fit, bacteria can penetrate and consequently cavities may occur
secondary (dissolve the cement). "There is no restoration that fits the tooth with a margin
perfect for always accumulating plaque. Most margins are open on average
from 100 microns (25-500 microns). Considering that the size of bacteria is 1-5 microns.
We must think that there is enough space to accumulate them. However, many of these
Restorations are successful which suggests that the virulence of the bacteria and the susceptibility of the
guests play a more important role than the mechanical aspects of margins. Today in
A margin of error of 50 microns is clinically considered acceptable, as long as, when passing the
probe at the tip in the area of the prosthetic margin, its presence is noticeable to the touch, the inaccuracy
it will be > 50 microns, that is, above the clinical tolerance limit.
The margin on the prosthetic stump must:

1. Be clear and linear

2. Provide enough space for restoration materials
3. Ensure the economy of the dental structure
4. Be simple in its execution

Overcontouring of the crowns.

The contour or emergency profile must harmonize with the natural tooth. The profile of the tooth
natural is flat and continues like this within the sulcus, so to achieve this with the prosthesis we
it must sufficiently reduce the gingival 1/3 of the crown. If reduced insufficiently (< 2mm),
the laboratory technician overfills in order to achieve the sufficient thickness of
restorative material. The facial or lingual bulging of the restoration should not be
0.5 microns from the gingival margin, as it could interfere with adequate plaque removal
(area inaccessible to oral hygiene). At the level of the furcations, the dental preparation must be at
base of a concavity from the furcation to the most coronal level.

The overcontour (produces accumulation of bacterial plaque and hinders normal hygiene habits)
it is more harmful to gum health than the subcontour.

Closed interproximal spaces.

The interdental spaces must be wide enough to protect the gingival ridge and
allow for proper hygiene (use of interproximal brushes) but narrow enough
to prevent dental mobility and food impaction. The most predictable way to
establishing an adequate and healthy interproximal space is created with a good provisional as much as possible
exactly possible that the definitive prosthesis.
Signs and symptoms of problems in the interproximal space:

- Edematous papilla
 - Open contacts that allow food impact
- Decapitated interdental papilla
- Loss of the dotted line
- Change from pale pink to purplish
- Dental malposition
- Excessive amount of restorative material
- Obliteration of the interproximal space
- Radiographic evidence of bone crest loss

It is important to keep the interproximal space free of bacterial plaque and the restoration.
it must allow it.

Poorly designed bridges.

Poorly designed pontics act as irritants to the periodontium.

Types of pontics

Hygienic pontic. In areas without aesthetic considerations. It is easy to clean but the food
gets trapped.
2. Pontic in a saddle. Difficult hygiene.
3. Point contact pontic or linear and without creating pressures (Modified-ridge lap). The ideal.
Pontics must meet the following requirements:

1. Aesthetically acceptable
2.Good occlusal relationships
3.Restore masticatory effectiveness
4.Designed to allow proper hygiene under the pontic and between the pontic and the
tooth (passage of silk thread or superfloss). The part of the pontic that faces the gum has
to be convex and smooth.
5.Keep a space for the passage of food
Incorrect provisional restorations.

Temporary restorations must be an acrylic parent of the restorations.

final. They should not be replaced until all treatment objectives have been met.
fulfilled.

Provisional restorations must have:

Good marginal adaptation

2. Contouring and physiological interproximal spaces
3. Polished surface, resistant to plaque
4. Strength and hardness
Good aesthetics and retention
Comfort during the performance
7. Easy cleaning and recementing