Biologic Shaping in Periodontal Therapy
Periodontal surgery involves modification of hard and/or soft tissues to achieve a therapeutic goal. These goals include treatment of periodontal defects, including furcation involvement of molars, and crown lengthening procedures to facilitate restoratio
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Biologic Shaping in Periodontal Therapy Danny Melker, Alan Rosenfeld, and Salvador Nares
4.1
Introduction
Periodontal surgery involves modification of hard and/or soft tissues to achieve a therapeutic goal. These goals include treatment of periodontal defects, including furcation involvement of molars, and crown lengthening procedures to facilitate restoration of a tooth or teeth. Traditionally, resective and regenerative techniques focus on osseous structures with little attention given to modification of tooth surface. Unfortunately, this could lead to excessive removal of the bone and/or creation of an environment that is not cleansable and biologically incompatible. Further, regenerative techniques can yield unpredictable results in furcation lesions thus predisposing molars to further attachment loss. Biologic shaping is intended to create a cleansable, biologically compatible root surface that is manageable by both patients and dentists/hygienists. Here modification of tooth surface is the primary focus with removal of the bone performed only when absolutely necessary to create a biocompatible environment. This chapter will focus on biologic shaping during the course of periodontal therapy.
Electronic supplementary material The online version of this chapter (https://doi. org/10.1007/978-3-030-12310-9_4) contains supplementary material, which is available to authorized users. D. Melker Private Practice Limited to Periodontics, Clearwater, FL, USA A. Rosenfeld · S. Nares (*) Department of Periodontics, University of Illinois at Chicago, College Dentistry, Chicago, IL, USA e-mail: [email protected]; [email protected] © Springer Nature Switzerland AG 2020 S. Nares (ed.), Advances in Periodontal Surgery, https://doi.org/10.1007/978-3-030-12310-9_4
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Indications and Rationale for Biologic Shaping
Biologic shaping was first reported by Melker and Richardson in 2001 and described for esthetic dentistry in 2003 [1, 2]. It combines periodontic and restorative phases of dentistry and aims to facilitate home care by patients using simple hygiene aids such as floss and a toothbrush, as well as facilitate professional maintenance by hygienists to remove plaque and calculus. It also creates biologically compatible dimensions necessary for the restoration of a tooth without infringement on biologic width. Further, biologic shaping removes tooth-derived risk factors such as developmental grooves, enamel projections, and concavities. This is particularly important if a developmental groove, concavity, or enamel projection is in close proximity to an existing crown margin resulting in a void or retainment of cement in the groove (Fig. 4.1). This can create an unmanageable situation and increases risk of further attachment loss. Therefore, the ideal therapy will involve modification of tooth structure to eliminate these anatomical discrepancies and create a new restorative margin that is supragingival to the previous margin. The point being that biologic shaping limits the unnecessary removal of
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