C. Clinical considerations

1.     Gingiva is considered to have a more stable relationship with the gingival margin of a restoration than alveolar mucosa.   If gingival tissue is deficient, gingival grafts may be used to create new gingiva.

2.     Gingival margins of restorations in young people are more likely to become exposed than in older subjects as a result of passive eruption.

3.     Periodontal probing does not accurately estimate the actual anatomic sulcus or pocket depth.  Probing depth generally overestimates anatomic sulcus or pocket depth because the probe actually penetrates inflamed tissues. The greater the inflammation, the greater the extent of probe penetration.  Reduction of inflammation through periodontal treatment, by reducing probe penetration, may reduce probing depth without necessarily producing new attachment of the periodontal tissues to the tooth.

4.    Gingival inflammation results in the production of an inflammatory exudate that flows from the inflamed connective tissue into the gingival sulcus or pocket.   It has been reported that, within limits, the greater the inflammation, the greater the fluid flow. This gingival (or crevicular) fluid contains inflammatory cells, lysosomal enzymes and various by-products of the inflammatory process.  Some of these products, such as enzymes and various cytokines have been the focus of studies aimed at developing better diagnostic tests.

5.    Gingival health is maintained primarily by control of microbial accumulations on teeth. The massaging effect of tooth cleaning procedures on tissue health is minimal. It is the ability of cleansing procedures to remove bacterial biofilms (or dental plaque) that keeps the tissues free of inflammation.

6.     Overhanging fillings contribute to periodontal disease primarily by favoring bacterial accumulation, rather than by direct irritation of the tissues.

University of Pennsylvania and Temple University © 1999. All rights reserved. Created: May 8, 1999  Revised: URL: Max A. Listgarten: Comments to author: max@listgarten.com (Technical Support: Center for Dental Informatics: Heiko Spallek)