**1. Introduction**

Gingiva, with its unique texture and coral pink color [1], is the most delicate tissue in the oral cavity and the first essential component of the periodontium (**Figure 1**).

*Why is it too much important to confirm a healthy gingiva before proceeding to dental treatment?*

Nowadays, the importance of gingiva is increasing because of its interrelationship with the general health and the direct esthetic effect on most dental treatments.

The teeth are supported and held in position within the alveolar bone by means of the periodontium. The latter consists of gingiva, periodontal ligament, alveolar bone, and cementum (**Figure 1**). The gingiva, which covers the alveolar bone, is classified as a masticatory portion of oral mucosa. Anatomically, there are three demarcated parts of gingiva. First, the marginal gingiva, which is the free end of gingiva with a smooth surface, enclosing the neck of the teeth as a collar shape to define the gingival sulcus. The second part is the attached gingiva which is stippled, firm, and strongly attached to the alveolar bone and to the cervical area of the tooth by means of junctional epithelium located in the floor of gingival sulcus. The conjunction between the free and attached gingiva is a shallow linear depression called gingival groove. The attached gingiva extends apically to the oral mucosa, from which it is demarcated by mucogingival junction (**Figure 2**). The third part is the interdental zone of gingiva, which is nonkeratinized and located in the area between the two adjacent teeth beneath the contact point [2].

The biological width or the supracrestal tissue attachment is a natural protective layer, which seals and preserves the periodontium from bacterial invasion, located in the deeper part of gingival sulcus and measuring 2.04 mm in depth, which is the sum of junctional epithelium 0.97 mm and supracrestal connective tissue attachment 1.07 mm (**Figure 3**).

These delicate anatomical structures of the periodontium should be respected and well considered by the dentist while planning and managing oral and dental diseases. Furthermore, any changes detected in the normal appearance or texture of gingiva as well as periodontal attachment might guide the dentist to a further investigation of oral or systemic disturbances.

#### **Figure 1.** *The periodontium components.*

**5**

**Figure 4.**

*Introductory Chapter: The Importance of Gingival Treatment and Prevention*

**achieved without insulting the periodontium?**

**2. How an esthetic result and successful dental treatment can be** 

junction, because this will result in a high incidence of gingival recession [3].

*The innovative parallel profile radiograph technique to determine the biological width.*

Endocrown is a new biomimetic design to restore the teeth after endodontic treatment. The tooth is prepared with circular butt-joint margins and central cavity inside the pulp chamber (**Figure 5**). This type of restoration will save the tooth

Another new conservative concept is the biologically oriented preparation technique used for both tooth and implant prosthodontics. It is also mentioned as vertical tooth preparation, meaning to prepare the tooth without a finishing line as a featheredge located 0.5 mm beyond the gingival margins, which in turn will cautiously induce gingival bleeding. The formed coagulate is preserved by using interim splinted acrylic resin prosthesis for nearly 6 weeks in order to enhance

The dental procedure is considered safe to the periodontium, providing there is no intervention in the biological width and specifically the epithelium junction. Therefore, care should be taken during tooth preparation, impression, retraction cords, temporary and permanent crowns, restorations, and also bleaching, in order not to invade the biological width and periodontium. Many dentists, before the revolution of esthetic dentistry, tended to set the margins of the crown or restoration too long beneath the gingiva, just to mask the interface between the tooth and crown edges. As a result, there will be more plaque accumulation, which is very difficult to be cleaned subgingivally. This might sometimes cause iatrogenic gingival and periodontal disease and unsightly exposed margins of the crown due to gingival recession. It has been further explained by investigators that subgingival edges of the restorations or crowns will change the subgingival flora to higher scores of gingival and plaque indexes with increasing the depth of gingival sulcus. Nevertheless, when the margins of the crown or restoration should be placed subgingivally in few special cases, the sulcus depth and the level of epithelium junction along with the alveolar bone crest must be precisely determined, by cautiously using either gingival probe or radiographs, such as Bitewing X rays or the innovative parallel profile radiograph technique (PPR) (**Figure 4**). Furthermore, care should be taken not to injure the marginal gingiva when the alveolar bone crest is lower than normal and the free gingiva is not well supported by enough depth of epithelium

*DOI: http://dx.doi.org/10.5772/intechopen.85653*

structure as well as the periodontium [4].

**Figure 2.** *The free and attached gingiva.*

**Figure 3.** *The biological width.*
