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biological width?

Saw a new pt today. #2-3 area 6mm pocket BOP and exudate, open contact for approx 18 months.#2 had an MO resin present that extended approx 3mm below gum line and #3 had a DO resin with a poor margin that extended approx 3 mm sub-g. I suggested sc/rp . doc came in and told pt that we would close the contact and he thought scrp wouldn’t help because bone will naturally be about 3 mm from the end of a restoration. I asked him about it later and said that he was talking about biological width. Thoughts?!



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5 Answers
Best Answer

The doctor must feel that the restoration is the cause and that SRP wouldn’t help. That pocket will probably never improve since you can’t get attachment past the biologic width. That being said, I would definitely be going in there to remove biofilm and making sure the root is smooth, it just may not require SRP.
Cases like this show us just how “precarious” certain restorations can be and how dynamic the oral health is. 🙂

More Answers

The biologic width is the space between the JE and the base of the pocket. When it is compromised the alveolar bone will resorb. This is why crown lengthening is sometimes done before a crown is done. They have to decrease the height of the alveolar bone to make way for the new restoration. I remember learning in school that the biologic width varies with each patient, somewhere between 1-4mm I think.

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I have run into cases like this fairly frequently. My boss never does crown lengthening when it is needed and tries to bury margins subgingivally, invading the biological width. Of course, this leads to bone loss and gums that bleed like a stuck pig. It’s frustrating, because SRP won’t help the real problem, but it’s pretty much all I personally have to offer. I usually try to refer these patients to a periodontist in the hope that they will suggest crown lengthening. It gets to be a touchy subject when it’s a restoration our office did that’s causing the problem. Any tips other people have on how to deal with this would be greatly appreciated!

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SRP may not be necessary if the pocket is a result of compromised biological width. It will not matter how much scaling you do, the pocket is not a result of calculus. Cavitroning to remove biofilm and irrigation with CHX may be the best you can do without crown lengthening.

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I wish I could post the x-ray! There was a good 3mm of bone loss from the edge of the restoration. So my hug brain says to me that sc/rp should be done to remove biofilm and poss calc? I guess my real question is, why wouldn’t sc/rp not be necessary?

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