**2. How an esthetic result and successful dental treatment can be achieved without insulting the periodontium?**

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

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 structure as well as the periodontium [4].

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

*Gingival Disease - A Professional Approach for Treatment and Prevention*

**4**

**Figure 3.**

**Figure 2.**

**Figure 1.**

*The periodontium components.*

*The free and attached gingiva.*

*The biological width.*

### *Gingival Disease - A Professional Approach for Treatment and Prevention*

gingival healing according to the new emergence profile (**Figure 6**). This innovative method will preserve the tooth structure and increase the thickness of gingiva as well. Moreover, the final finishing line will be determined by the technician depending on gingival formation caused by tissue remodeling, and the emergence profile can also be modulated [5]. Actually, the dentist had better select whether to prepare the tooth with horizontal or vertical finishing line depending on his diagnosis, esthetic requirements, gingival health, and patient cooperation. Similarly, a conical implant can be used without a finishing line in order to set the gingival margins on the prosthetic crown rather than the abutment. Therefore, the restoration-abutment interface will mimic the cement-enamel junction and the natural tooth emergence as well. Subsequently, the peri-implant gingiva will be thicker, more stable, and well-adapted to the new prosthetic shape [6].

The well-organized treatment plan is the gold standard for successful dental therapy. The dentist should prioritize his goals of the dental procedures in order to meet the patient's expectations with long-term success. Unfortunately, the gingiva is not as much important as dental caries from the viewpoint of many patients, whereas it is the first priority of the dentist in order to ensure that the teeth, to be treated and rehabilitated, are well supported by a strong healthy periodontium. Therefore, any gingival or periodontal inflammation should be treated ahead of prosthodontic procedures, and seriously considered during and after dental treatment. The traumatic occlusal forces, either primary or secondary, should be

#### **Figure 5.**

*The endocrown. (A) Tooth preparation. (B) endocrown. (C) After cementation.*

#### **Figure 6.**

*The biologically oriented preparation technique. (A) Before treatment, (B) after vertical preparation, (C) the interim splinted acrylic resin prosthesis, and (D) the attached gingiva after treatment.*

**7**

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

considered in the treatment plan of gingival diseases. However, there is no clear evidence that these traumatic forces will aggravate periodontitis [7, 8]. Rarely, the gingival inflammation could not be controlled by normal hygiene methods and might be induced by hypersensitivity of dental materials. Other factors to be investigated while planning gingival treatment are excessive orthodontic forces out of the adaptive capacity of periodontium, thickness of gingiva, and smoking

**3. Is the correlation between gingival diseases and systemic health** 

Gingivitis is defined as an inflammation induced by plaque accumulation and accompanied with redness, bleeding, and edema, and sometimes it might be painless as a silent chronic disease. If this inflammatory process is left untreated, it may turn into a dangerous progressive disease, with continuous bone and attachment

There are two directions regarding the relationship between the gingiva and systemic diseases; the first one explains the impact of systemic disturbances and illnesses on the gingiva and periodontium, while the second one describes the possible

1.Systemic disturbances which influence the periodontal inflammation and have

○ Diseases correlated with immunologic disorders, such as Down syndrome and

○ Diseases which affect the oral mucosa and gingival tissue. For example, dystro-

○ Diseases with negative effects on the connective tissues, like Ehlers-Danlos

○ Metabolic and endocrine disturbances, namely hypophosphatasia.

• Inflammatory diseases. Epidermolysis bullosa acquisita for example.

2.Other systemic disorders influencing the pathogenesis of periodontal diseases out of which are osteoporosis particularly related to postmenopausal [12], rheumatoid arthritis, osteoarthritis [13], and obesity which might affect periodontitis through hyperglycemia [14]. In addition, diabetes mellitus is also considered as a modifying factor of periodontitis by means of hyperglycemia resulted from type I or II diabetes [15]. Furthermore, the medications typically used for the treatment of malignancies, malnutrition, vitamins deficiency [16], nicotine dependence and psychological stress are also exacerbating fac-

• Acquired immunodeficiency diseases as seen in HIV infection.

effects of gingival and periodontal diseases on the general health.

a considerable impact on the periodontal attachment:

leukocyte adhesion deficiency syndromes.

phic epidermolysis bullosa and epidermolysis bullosa.

**3.1 The first direction was classified by Al-Bandar et al.**

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

**considered one or two way?**

loss, referred to as periodontitis [11].

• Genetic abnormalities.

syndromes.

tors of periodontal diseases.

[9, 10].

*Introductory Chapter: The Importance of Gingival Treatment and Prevention DOI: http://dx.doi.org/10.5772/intechopen.85653*

considered in the treatment plan of gingival diseases. However, there is no clear evidence that these traumatic forces will aggravate periodontitis [7, 8]. Rarely, the gingival inflammation could not be controlled by normal hygiene methods and might be induced by hypersensitivity of dental materials. Other factors to be investigated while planning gingival treatment are excessive orthodontic forces out of the adaptive capacity of periodontium, thickness of gingiva, and smoking [9, 10].
