Periodontal considerations for fixed prosthodontics: a literature review

Periodontal health is crucial for the long-term success of fixed tooth supported prosthodontics. The focus has always been on the prosthesis mechanical properties. However, most of the clinical complications are biological as caries and periodontal disease which underscores the importance of coordinated interdisciplinary treatment planning. This review explores the critical periodontal dimensions and their implications for fixed prosthodontics. The gingival level and zenith points affect the extensions and esthetics of fixed prosthodontics while gingival biotype influences the risk for gingival recession and the esthetic outcome of the treatment. The width of attached gingiva was once deemed critical for periodontal health. But currently it is inconsequential in the presence of good oral hygiene. Yet, adequate attached gingiva is essential to minimize the risk of gingival recession in sites with subgingival restorations. The presence of full interdental papilla is vital for esthetics. The construction of lost papillae can be done surgically or non-surgically, but it is very challenging and unpredictable. The biologic width represents the physiologic seal protecting the underlying bone and its violation will lead to chronic inflammation due to apical displacement of microbiologic contact zone closer to the bone. However, it cannot be clinically measured when compared to the dentogingival complex which can be accurately measured and more clinically relevant. Also, the evaluation of the magnitude of the periodontal support in terms of crown to root ratio and number of abutment teeth is essential especially when planning complex fixed dental prosthesis in periodontitis patients. All these factors should be considered and its relationship to the margins of fixed tooth supported prosthesis should be respected to ensure its long-term success.