Kl. Knoernschild et Sd. Campbell, Periodontal tissue responses after insertion of artificial crowns and fixed partial dentures, J PROS DENT, 84(5), 2000, pp. 492-498
Purpose. The purpose of this review was, first, to critically evaluate publ
ished evidence on the effects of artificial crowns and fixed partial dentur
es (FPDs) on adjacent periodontal tissue health, and second to synthesize t
his evidence into meaningful summaries. Restoration qualities that contribu
te to inflammatory responses were identified based on strength of evidence,
and variables that should be controlled in future investigations were outl
ined. Such information is necessary to accurately predict the prognosis of
peri odontal tissues adjacent to crowns or FPDs.
Methods. Clinical trial and epidemiologic evidence published in English was
collected. The effects of crowns or FPDs on gingival inflammation, probing
depths, and bone loss were evaluated based on accuracy of measurement, rel
iability of measurement, and/or appropriateness of data analysis.
Results. Crowns and FPDs increased the incidence of advanced gingival infla
mmation adjacent to restorations, particularly if restorations had intracre
vicular finish Line placement, poor marginal adaptation, or rough surfaces.
However, because of the limitation in the accuracy and reliability of prob
ing depth measurements, reports of greater mean probing depths of crowned t
eeth, which tended to be less than 1 mm greater than control teeth, should
be questioned. Finally, crowns and FPDs in general did not accelerate the r
ate of adjacent bone loss.
Conclusion. Clinically deficient restorations, as well as clinically accept
able restorations, can contribute to gingival inflammation. However, with t
he limitations of the applied methods of measurement, current evidence has
not shown an increased attachment loss adjacent to crowns or FPDs. Future t
rials should document periodontal health before therapy and periodically af
ter restoration insertion so that each tooth selves as its own control. In
future studies, the periodontal disease history of the patient, the influen
ce of the restoration on plaque formation, and the composition of the crevi
cular microflora must be recorded.