biologic width is not predictable - dentaltown€¦ · biologic width is not predictable danmelker...

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62 dentaltown.com March 2005 Periodonticstown Continued on page 64 message board Biologic Width Is Not Predictable danmelker | Danny | Total Posts: 1,404 | Member Since: 7/26/2003 | Posted: 11/29/2004 9:31:59 AM | Post 0 of 25 Hey, how many of us have taken a course talking about the BW and bone sounding. I have heard a ton of lecturers say the BW is pretty predictable from tooth to tooth and adjacent teeth especially. A lot of us do our surgeries with this concept in mind. This is why I NEVER do GVs or closed-flap crown lengthening. I never have to worry about the unexpected, which occurs all the time. I invite you to attend a course May 20, 2005 at the Sheraton Sand Key in Clearwater, Fla. with Bill Strupp and myself. PERIO-REST. If inter- ested e-mail [email protected]. IFixTeeth2000 | Mark Dolson, DDS | O’Fallon Family Dentistry | Total Posts: 302 | Member Since: 5/14/2001 | Location: St. Louis, MO | Posted: 11/29/2004 12:09:15 PM | Post 2 of 25 What was the chief complaint? What is planned, if anything, for this patient? danmelker | Danny | Total Posts: 1,404 | Member Since: 7/26/2003 | Posted: 11/29/2004 12:50:02 PM | Post 4 and 5 of 25 Chief complaint was a gummy smile. What is important from this case is not the outcome, but how it was arrived at. There is a general thought being taught that the BW in an individual is pretty much the same from tooth to tooth. Those doing surgery routinely use this thought when doing their procedure. Why I recommend visibility and flap surgery is based on the regular evaluation of BW being different from tooth to tooth. A flap allows you the ability to go with the flow. Anything can be treated because you have the tissue to place wherever you want. Failure is eliminated by the ability to see what trt. needs to be undertaken. To find more information on the course being given on May 20, 2005 search: Forums » Message Boards » Main » Periodontics » Periodontics » Clarification of course Pictures 4 & 5: Post-op Picture 1: Simple altered passive eruption and altered active eruption? Picture 2: Oh my! Look at that BW of #8 and #9. Normal on #8, and NO BW on #9. This goes against what a lot of courses are teaching!!!!! Picture 3: Osseous correction of #9 to create a space for the BW

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Page 1: Biologic Width Is Not Predictable - Dentaltown€¦ · Biologic Width Is Not Predictable danmelker | Danny | Total Posts: 1,404 | Member Since: 7/26/2003 | Posted: 11/29/2004 9:31:59

62 dentaltown.comMarch 2005

Periodonticstown

Continued on page 64

message board

Biologic Width Is Not Predictable

danmelker | Danny | Total Posts: 1,404 | Member Since: 7/26/2003 | Posted: 11/29/2004 9:31:59 AM | Post 0 of 25Hey, how many of us have taken a course talking about the BW and bone sounding. I have heard a ton

of lecturers say the BW is pretty predictable from tooth to tooth and adjacent teeth especially. A lot of us doour surgeries with this concept in mind. This is why I NEVER do GVs or closed-flap crown lengthening. Inever have to worry about the unexpected, which occurs all the time. I invite you to attend a course May20, 2005 at the Sheraton Sand Key in Clearwater, Fla. with Bill Strupp and myself. PERIO-REST. If inter-ested e-mail [email protected].

IFixTeeth2000 | Mark Dolson, DDS | O’Fallon Family Dentistry | Total Posts: 302 | Member Since: 5/14/2001 | Location:St. Louis, MO | Posted: 11/29/2004 12:09:15 PM | Post 2 of 25

What was the chief complaint? What is planned, if anything, for this patient?

danmelker | Danny | Total Posts: 1,404 | Member Since: 7/26/2003 | Posted: 11/29/2004 12:50:02 PM | Post 4 and 5 of 25

Chief complaint was a gummy smile. What is important from this case is not the outcome, but how itwas arrived at. There is a general thought being taught that the BW in an individual is pretty much thesame from tooth to tooth. Those doing surgery routinely use this thought when doing their procedure.Why I recommend visibility and flap surgery is based on the regular evaluation of BW being differentfrom tooth to tooth.

A flap allows you the ability to go with the flow. Anything can be treated because you have the tissue toplace wherever you want. Failure is eliminated by the ability to see what trt. needs to be undertaken.

To find more information on the course being given on May 20, 2005 search: Forums » Message Boards » Main » Periodontics » Periodontics » Clarification of course

Pictures 4 & 5: Post-op

Picture 1: Simple alteredpassive eruption and alteredactive eruption?

Picture 2: Oh my! Look atthat BW of #8 and #9.Normal on #8, and NOBW on #9. This goes againstwhat a lot of courses areteaching!!!!!

Picture 3: Osseous correctionof #9 to create a space forthe BW

Page 2: Biologic Width Is Not Predictable - Dentaltown€¦ · Biologic Width Is Not Predictable danmelker | Danny | Total Posts: 1,404 | Member Since: 7/26/2003 | Posted: 11/29/2004 9:31:59

64 dentaltown.comMarch 2005

Periodonticstown >> message board

Continued from page 62

Continued on page 66

Glenn van As | Total Posts: 1,373 | Member Since: 4/8/2002 | Location: Deep Cove, BC | Posted: 11/29/2004 11:20:41PM | Posted 7 of 25

Danny, neat case and thanks for sharing. I for one could see how perhaps this could be of concern withvarying BW on individual teeth when lasers are used for closed-flap cases in the maxillary anterior. It’s toughto see what you are doing and you must depend on feel and accurate bone sounding. How easy is it to doclosed-flap for big cases like this one? Perhaps open flap visualization for NON-LOCALIZED osseousrecontouring is the way to go.

I know this is a topic of concern amongst a lot of periodontists at present and also with a lot ofesthetic dentists.

Tom Groom | Total Posts: 34 | Member Since: 2/28/2004 | Location: U.S. Military Academy West Pt. | Posted: 11/30/20046:50:59 PM | Post 8 of 25

Danny, am I right thinking this pt has altered-passive eruption on 6, 7, 8, 10, 11, and altered-active on#9? Is this an unusual case?

You’re right about being taught that BW is consistent, especially adjacent teeth. That’s been almost anabsolute in the courses I’ve had. Danny, what then is the best technique to prep for a porc/metal crown andprotect the BW and still insure against margin exposure with later recession? I sure can’t flap all my C&Bcases to see what’s there. Kois sounds, Spear uses sulcus depth, Bill would do feldspathic and stay supragingi-val, but I can’t always do that.

dkimmel | David | Florida Center for Laser Dentistry | Total Posts: 6,805 | Member Since: 7/6/2000 | Location: BayonetPt., FL | Posted: 11/30/2004 6:54:51 PM | Post 9 of 25

This is a great case to show the difference in BLW in the same patient on the same arch. Makes yourethink what we have been taught. What I have also noticed is that this variation in BLW appears to bemore the norm in these types of cases.

Rethinking what we have been taught or not taught is going to be a big part of this course. It will makeyou think and let you see periodontics from a restorative perspective. It will also let you see what a periodon-tist has to work with. If you have not done perio sx it is an eye-opener to see the relationship of osseous con-

tours and the gingiva. You’ll see a ton of cases with yearsof post-op follow up.

It seems Danny has gotten Strupp back to his rootsand is presenting at this course as well. This should beStrupp at his best. One of the surgeries I observed wasone of Strupp’s cases. The max arch was in temps. Thesetemps looked better than most finished crowns I haveseen. The margins were smooth and dead on. The coresand preps were all ideal text book preps. We shouldcome away with some great pearls.

The key to perio/restorative cases is putting together agreat team to work with. Danny has been talking withperiodontists to bring their restorative dentists with themto this course. I think as restorative dentists we should bebringing our periodontists with us to this course.

This course will change the way you think about perio.

drjcann | John Cannariato | Total Posts: 3,063 | MemberSince: 10/16/2002 | Location: Tampa, FL | Posted:11/30/2004 7:03:51 PM | Post 10 of 25

David, I could not agree more. You hitit on the head. I am going to ask 2 of theperio guys I use here to go; I will see whatthey say. If they do not then I have torethink using them.

Danny in cases like this it is, as yousaid, imperative to do an open flap. I am not sure thatSpear said what you believe he is saying. He showed aton of cases that were perio pros. Flaps were done in allthe cases and the tissue and bone recontoured. I do notremember one case where he did not do that.

FREE FACTS, circle 50 on card

Page 3: Biologic Width Is Not Predictable - Dentaltown€¦ · Biologic Width Is Not Predictable danmelker | Danny | Total Posts: 1,404 | Member Since: 7/26/2003 | Posted: 11/29/2004 9:31:59

66 dentaltown.comMarch 2005

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Actually you and I will be seeing Kois next year at the Study Club so it will be interesting. He is going togive his lecture entitled perio/restorative interface. I saw this lecture in Orlando. I cannot wait for him topresent this again, so you can ask him how he comes up with his conclusions. I am very interested to see hisresponse myself.

Keep posting the awesome cases, keeps us on our toes.

danmelker | Danny | Total Posts: 1,404 | Member Since: 7/26/2003 | Posted: 11/30/2004 7:42:15 PM | Post 11 of 14Tom, quality of tissue-dense connective tissue protects against recession and spreading bacteria to bone. In my

mind recession is caused by a couple things none of which has to do with the material being used. Following: 1. Rough margins of a crown that does not fit.2. Insufficient connective tissue (attached is the key) most often misdiagnosed situation. Just because

there is connective tissue in an area does not mean it is attached. 3. Retraction cord placed where it damages the attachment causing a junctional epithelial attachment

(very weak). 4. Overcontoured crown.So, I guess what I am saying is, if a one retraction cord technique is done properly and an excellent

impression is taken with a lab tech. doing ideal margins with sound perio––that is what, to me, preventsrecession.

John brought up a good point. I do not believe Dr. Spear advocates CLFCL as John thought I said.There are 2 parts to this thread:

1. I believe Dr. Kois and Dr. Spear say you can sound a tooth for BW and that is pretty much what you could expect in the area especially adjacent teeth. This violates that concept.

2. Those who do CLFCL would find it hard to end up with a successful result without open flap.

dkimmel | David | Florida Center for Laser Dentistry | Total Posts: 6,805 | Member Since: 7/6/2000 | Location: BayonetPt., FL | Posted: 12/1/2004 5:53:24 AM | Post 15 of 25

BLW is important but I am hoping Danny is going to go more in depth in other areas of perio sx aswell. Watching his sx I have gotten a better feel for the parabolic architecture of bone. How being tooaggressive in the papillae regions with the osseous can lead to shadowing of the line angles of the affectedteeth. Why he pulls the papillae to the buccal or lingual. What problems rotated teeth cause.

Like I said it should be a good course.

dr. steve | Total Posts: 59 | Member Since: 5/3/2001 | Location: New York | Posted: 12/1/2004 8:38:23 AM | Post 16 of 25Guys, I was in Boston in March 2004 for Frank Spear’s Restorative Update. I specifically remember him

showing slides similar to this case. His point was that Biologic Width is variable even in the same mouth.This is a definite change from his lectures several years ago. He quoted the 1961 study by Gargiulo, Wentz,and Orban that average BW is 2.0, but he also quoted the Vacek, et al 1994 study that showed a range of.75 mm to 4.3 mm.

He recommended using the base of the sulcus as a reference point for margin placement, i.e. don’t vio-late the base of the sulcus with your margin!

But this part of his lecture is all about sub-gingival margin placement and where to place it. If we areonly doing supragingival margin placement––it’s less of an issue.

danmelker | Danny | Total Posts: 1,404 | Member Since: 7/26/2003 | Posted: 12/1/2004 11:53:34 AM | Post 17 of 25Steve, you are right on the money. My reason for this thread was to have those doing 2 particular proce-

dures to hopefully reevaluate what the procedure offers.1. Doing GVs can be a real problem if we use averages. Flaps allow us to go with what we find and

correctly deal with the situation.2. Closed-Flap Crown Lengthening can be a real problem for the same reasons.Obviously, Spear has changed his presentation, which is what it is all about. Change is good. Doing

major perio/restorative cases requires understanding perio from a restorative point of view and rest, from aperio point of view!

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