Presentation1/ dental crown & bridge courses

PROSTHODONTICS-PERIODONTICS :
AN INTERDISCIPLINARY APPROACH IN
THE SUCCESS OF FIXED PARTIAL
DENTURE TREATMENT
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

CONTENTS:
INTRODUCTION
ANATOMY OF THE PERIODONTIUM
DIAGNOSIS AND TREATMENT PLANNING
PREPARATION OF THE PERIODONTIUM FOR FPD:
-PHASE I THERAPY
-MANAGEMENT OF POCKETS AND EDENTULOUS
MUCOSA
-MANAGEMENT OF MUCOGINGIVAL PROBLEMS
-CROWN LENGTHENING PROCEDURES
-RIDGE AUGUMENTATION PROCEDURES

PROSTHO-PERIO INTERRELATIONSHIP:
-OCCLUSION AND PERIODONTIUM
-SPLINTING
-GINGIVAL DISPLACEMENT FOR MAKING
IMPRESSIONS
-EMBRASURES
-CONTOURS OF RESTORATIONS
-PONTIC DESIGN
-RESTORING THE FURCATED OR RESECTED TEETH

The preservation of a healthy periodontal
attachment is the most significant factor in the
long term prognosis of a restored tooth. The
ideal goal for prosthodontic work should be to
make conditions adjacent to fixed single crowns
and bridges as favourable as around natural
teeth and not to initiate pathologic processes
that may endanger the longevity of the abutment
tooth.

PERIODONTIUM
GINGIVA
Its the part of the mucosa that covers the
alveolar process of the jaws and surrounds the
necks of the teeth.

PERIODONTAL LIGAMENT
It’s the connective tissue that surrounds the root
and connects it to the bone
Its mainly made of collagen fibers - principle
fibers
Attachment complex – Supracrestal fibres
- Junctional epithelium
CEMENTUM
ALVEOLAR BONE: PORTION OF MAX AND MAND THAT
FORMS AND SUPPORTS TOOTH SOCKETS…

PREPARATION OF PERIODONTIUM FOR
RECEIVING FIXED PARTIAL DENTURE:
EXAMINATION DIAGNOSIS AND TREATMENT
PLANNING:
Detailed case history report
Extra oral examination-swellings, asymmetry,
lymph nodes…..
Intraoral examination:

Examination of the teeth
-Wasting diseases
-Dental stains
- Hypersensitivity
- Proximal contact relations
- Tooth mobility
- Pathologic migration
- Dentition with Jaws closed

Examination of the periodontium
Plaque and calculus
Gingiva
Indices: Gingival index (Loe and Silness), The
sulcus bleeding index (Muhlemann and Son)
Periodontal pockets
Level of attachment v/s pocket depth
Amount of attached gingiva
Alveolar bone loss
Periodontal, Gingival and Periapical abscesses

. Gingival and periodontal disease must be
eliminated before restorative procedures are
begun for the following reasons:
1. Tooth mobility and pain interfere with
mastication and function of restored teeth.
2. Inflammation of the periodontium impairs
the capacity of abutment teeth to meet the
functional demands made on them. Restorations
constructed to provide beneficial functional
stimulation to a healthy periodontium become
a destructive influence when superimposed on
existing periodontal disease, shortening the life
of the teeth and the restoration.www.indiandentalacademy.com

. 3.The position of teeth is frequently altered in periodontal
disease.
4 Partial prostheses constructed on casts made from
impressions of diseased gingiva and edentulous mucosa do not
fit properly when periodontal health is restored.
5. Margins of restorations hidden behind diseased gingiva are
exposed when the inflamed gingiva shrinks following periodontal
treatment.
Furthermore, the aims of periodontal treatment are not limited to
the elimination of periodontal pockets and the restoration of
gingival health. Treatment should also create the
gingivomucosal environment and the osseous topography
necessary for the proper function of single-tooth restorations and
fixed and removable partial prostheses.

.
. PHASE I THERAPY:
The removal of etiologic factors causing gingival
inflammation results in a return to a more healthy
gingival state within 1 or 2 weeks. Thus plaque control,
calculus removal and the removal or correction of any
inadequate dental restorations in the gingival
environment should be important first order procedures.

.
. PERIODONTAL SURGERY:
MANAGEMENT OF POCKETS AND EDENTULOUS
MUCOSA:
The area is prepared for the prosthesis with the following
objectives:
1. To establish a healthy gingival sulcus. The pontics
adjacent to the natural teeth can be designed to create
the gingival embrasure necessary for preservation of
gingival health.
2. To eliminate extraneous mucosal tissue to permit
adequate vertical space for the replacements.
3. To provide a firm, healthy mucosal base
for placement of saddles or pontics

In certain situations when pockets occur in areas
adjacent to edentulous areas a flap operation may be
used to eliminate these pockets and at the same time
provide a maintainable contour of the edentulous ridge
region.
.

CROWN LENGETHENING:
To overcome problems with a gummy smile:
-Patients with a high lip line and “short front teeth”
They are of two types:
Where the clinical crown is shorter than the anatomical
crown:
Rx : Gigivectomy procedure
Where the anatomical crowns are short: With or without
normal occlusal relationships and incisal guidance.
Rx: Combined Periodontal resective therapy with
Prosthodontic procedure

To Expose sound tooth structure:
Crown lengthening procedures may be required to
solve different problems such as:
-Sub gingival location of carious lesions
-Sub gingival location of fracture lines
-Inaccessibility of sub gingival margins of failing
restorations
-Inaccessibility of subgingivally prepared tooth
structure for proper impressions
Rx: Apically positioned flap procedure including bone
resection
Slow eruption of teeth
Rapid eruption of teethwww.indiandentalacademy.com

Apically positioned flap procedure including bone
resection:
Indication: Crown lengthening of multiple teeth in a
quadrant or sextant of the dentition.
Contraindication; Crown lengthening of single tooth
especially in anterior regions

Slow eruption of teeth(Reitan1967, Heithersay 1973,
Ingber 1974, Simon et al 1978, Lythgoe et al 1980):
If moderate eruptive forces are used the entire
attachment apparatus will move in unison with the
tooth. Afterwards a full thichness graft is elevated and
bone recontouring is performed .
Indications: At sites where removal of attachment and
bone from adjacent teeth must be avoided.

Contraindication: in patients with few remaining teeth
Rapid eruption of teeth:
Indications: Crown lengthening at sites where it is
important to maintain the location of gingival margin
at adjacent teeth unchanged.
Contraindication: Angular bony defects

RIDGE AUGUMENTATION PROCEDURE:
These procedures are directed to correct the excessive
loss of alveolar bone that sometimes occurs in
the anterior region as a consequence of ad-
vanced periodontal disease, advanced periapical
bone loss, traumatic tooth extractions, external
trauma, and so forth. This excessive bone loss
may create a difficult aesthetic problem and
complicate the prosthetic reconstruction. These
osseous defects may occur in a coronoapical
direction, in a buccolingual direction, or in both
directions simultaneously.www.indiandentalacademy.com

Several prosthetic solutions have been pro-
posed for this problem, and the following surgical
techniques have been suggested:
Placement of a thick mucosal autograft
obtained from the palate or the tuberosity
Placement of a connective tissue graft
beneath a full or partial thickness flap or in a
"tunnel" created by a lateral incision.
The roll technique described by Abrams,'
which consists of elevating a flap over the
deformed area, de-epithelializing its terminal
half, and rolling it under the flap, thereby
thickening the tissue in the deformed site

Placement of non-porous, dense hydroxy-
apatite under a split thickness flap or a pouch
created under a full thickness flap.
A double flap technique for use in conjunction
with porous hydroxyapatite or other materials to
cover the graft while expanding the volume of the
area.

RIDGE REDUCTION AND REMOVAL OF TORI
AND EXOSTOSES.
Sometimes ridges may be too
voluminous, or the presence of tori and exos-
toses may interfere with the prosthetic recon-
struction. These areas of excessive osseous tis-
sue are removed with chisels and/or burs after
raising a full thickness flap.

OCCLUSION AND THE PERIODONTIUM:
When there is increased functional demand upon the
periodontium it commonly accommodates these
forces. The effect of occlusal forces upon the
periodontium is influenced by their severity,
direction, duration and frequency. When occlusal
forces exceed the adaptive capacity of the
periodontium, tissue injury results. Periodontal
injury caused by occlusal forces is called TFO.

Primary TFO: Alteration of occlusal forces….
Eg. High filling, prosthetic replacement with high
points, drifting / extrusion of teeth, orthodontic
movement of teeth into functionally unacceptable
positions.
Secondary TFO: Reduced ability of tissues……
Clinical and Radiographic Signs:
Tooth mobility
Increased width of periodontal space
Vertical destruction of interdental septum
Root resorption www.indiandentalacademy.com

OCCLUSAL ADJUSTMENT BEFORE
PROSTHESIS PLACEMENT
Traumatic occlusal relationships should be eliminated
before restorative procedures are begun, and
restorations should be constructed in conformity with
the newly established occlusal patterns. If this is not
done, the prosthesis perpetuates occlusal
relationships injurious to the periodontium. The
harmful effects of occlusal trauma are not confined to
the teeth involved in the restoration and their
antagonists.

Other areas of the dentition are secondarily affected by
an occlusal disharmony created or perpetuated by an
inlay or bridge. Delaying occlusal adjustment until
the restorations are inserted may require grinding
through the occlusal surface of the newly constructed
restorations. The occlusion must be checked at regular
intervals after a prosthesis is inserted. Occlusal
relationships change with time as the result of wear of -
restorative materials and setting of saddle areas of
removable prostheses, especially those without distal
support.

BIOLOGIC WIDTH: (Gargiulo,1961)
SUBCREVICULAR PHYSIOLOGIC DIMENSION:
( Maynard and Wilson, 1979)
It’s the dimension of space that the healthy gingival tissues occupy above
the alveolar crest.
It refers to the combined connective tissue-epithelial attachment from the
crest of the alveolar bone to the base of the sulcus.

Nevins and Sukrow in 1984 recommended that for the
maintenance of healthy periodontium, no restoration
should violate the attachment ,even though its not
possible for a clinician to identify the most coronal
extent of the junctional epithelium.
Wilson and Maynard cautioned against extending
restorations so far subgingivally that the attachment
complex is damaged. They stated that some distance
of unprepared tooth structure should remain between
the finished line and junctional epithelium and this
distance should be ideally 0.5mm.
Eissman et al recommended that restorations not be
placed at or near the alveolar crest and there must be
2mm of root surface between the alveolar crest and
the restoration.

SPLINTING:
A splint is an appliance for the immobilization and
stabilization of injured or diseased parts. Teeth may be
splinted as part of Phase I therapy utilizing temporary or
provisional splints. Permanent splints can be placed in
the form of cast restorations as part of restorative phase
therapy. It has three purposes:
1. To protect loose teeth from injury during stabilization
in a favourable occlusal relationship.
2. To distribute occlusal forces for teeth weakened by
loss of periodontal support
3. Prevent natural teeth from migratingwww.indiandentalacademy.com

Splinting methods:
Temporary: Ligature wire, A-splint or circumferential
wiring, removable appliances, bonding
Provisional: heat processed acrylic restorations.
Permanent…. Cast splints: Rigid connectors, Non rigid
connectors, Telescope crowns
.

COMPLETE OR PARTIAL COVERAGE:
Partial veneer crowns have less resistance to
deformation than complete crowns and this increases
cement fracture with loss of retention. Thus complete
crowns are preferable as retainers in patients with long
span FPD s or splints with few abutment teeth
“ Partial veneer crowns have less resistance to
deformation than complete coverage crowns { Lindhe,
Nymans, 1977} and this increases cement fracture with
loss of retention{ Timoshenko S.P}”

MARGIN PLACEMENT:
Whenever possible margins are placed supragingivally
on the enamel of the anatomic crown.
Advantages:
Favourable reaction of the gingiva.
Common path of insertion.
Wider shoulder preparation possible without injury to
the pulp.
metal margin finishing will be easier.
Despite the advantages of supragingival finish
placement there are situations where intracrevicular
placement of margins is indicated such as :
Esthetics
Severe cervical erosion
Restorations or caries extending beyond the gingival
crest

Adequate crown retention in short or broken down
clinical crowns.
Elimination of persistent root hypersensitivity.
THE COMFORT OF THE PATIENT SUBJUGATES ALL
GUIDE LINES.
Accurate measurement of the true gingival crevice is
important to ensure that margins do not impinge on
the junctional epithelium or the connective tissue
attachment using the periodontal probe.
Authors have estimated the true crevicular depth to be
between 0.5-3mm. Hence the ideal intracrevicular
position for margins is 0.5mm beneath the gingival
crest. www.indiandentalacademy.com

In 1974 Guy M Newcombe studied the relationship
between the location of the subgingival crown margins
and gingival inflammation. He divided 50 patients and
their controls into groups based on the distance of the
crown margin from the base of the crevice(CM-CB)
Group I CM-CB-0.25 mm
Group II CM-CB-0.5mm
Group III CM-CB-0.75mm
Group IV CM-CB-1.0mm . From the study he concluded
that:
- The difference in the mean plaque index,mean
gingival index and mean crevicular depth between
crowned and control teeth was statistically significant.
- The nearer a subgingival margin approaches the base
of gingival crevice the more likely it is thqat severe
inflammation will occur

-The least inflammation is observed when
subgingival crown margins are placed at the gingival
crest or just into the gingival crevice.

GINGIVAL RETRACTION AND IMPRESSIONS:
Impressions of intracrevicular finish lines may be
extremely injurious to the periodontium depending to a
great extent on the quality and quantity of the attached
gingiva and the type of retraction. All retraction
methods induce transient trauma to the junctional
epithelium and connective tissue of the gingival
sulcus.
Methods for gingival retraction can be classified as:
Mechanical – Copper band or tube Impression using
impression compound or elastomer
Chemicomechanical : Retraction cord with 8% racemic
epinephrine, alum or Phenylephrine hydrochloride
Surgical: Rotary curettage and Electrosurgery

Techniques of gingival retraction using retraction cords:
Single cord technique.
Double cord technique.
Infusion technique of gingival displacement.
Every other tooth technique

Ruel Jon in 1980 carried out histological study on
humans by using retraction cord (Adrenaline)
electrosurgery and copper band.
Copper band – give the most satisfactory results
even with incisal wound, healed within 4 days.
Retraction cord showed damage to sulcular and
junctional epithelium and underlying connective
tissue.
Electrosurgery – showed annihilation of sulcular
epithelium the healing was relatively slow (16-24
days) and gingival recession of 0.6mm.

Dr.Sunil Kumar under the able guidance of Sir
conducted a study on clinical evaluation of different
gingival retraction procedures and their effects on
gingival health in which effect of electrosurgery,
retraction cord (Aluminium chloride 10%), rotary
curettage procedure on gingiva. Concluded that rotary
curettage group showed the least changes for plaque
accumulation, gingival sulcus depth, gingival index and
gingival height. Even study shows that retraction
procedure shows minor tissue damage.

THE EMBRASURES:
When teeth are in proximal contact, the
spaces that widen out from the contact are
known as embrasures. The interdental
space is divisible into a facial and a lingual
embrasure an occlusal or incisal
embrasure that is coronal to the contact
area and a gingival embrasure, which is
the space between the contact area and
the alveolar bone. The gingival embrasure
is filled with soft tissue, but in periodontal
disease spaces are created in the gingival
embrasure.

THE GINGIVAL EMBRASURE:
Embrasures are
critical considerations in restorative
dentistry,
Proximal surfaces of dental restorations
are important because they create the
embrasures essential for gingival health
From the periodontal viewpoint, the
gingival embrasure is the most significant.
The proximal surfaces of crowns should
taper away from the contact area facially,
lingually,and apically. Excessively broad
proximal contact areas and inadequate
contour in the cervical region crowd out the
facial and lingual gingival papillae lead to

CROWN CONTOURS:
The facial and lingual contours of restorations
are also important in the preservation of
gingival health. The most common error in
recreating the contours of the tooth in dental
restorations is overcontouring of the facial and
lingual surfaces. In one study approximately 80
per cent of full gold crowns were wider than
the tooth they were replacing, and all porcelain-
bonded-to-metal crowns were too wide
buccolingually. This overcontouring generally
occurs in the gingival third of the crown and
results in an area where oral hygiene
procedures are unable to control plaque.
Consequently, plaque accumulates and the
gingiva becomes inflamed. Apparently
undercontouring is not as damaging as

Yuodelis, Weaver and Sapkos in 1973 discussed the
effect of facial and lingual contours af artificial
complete crown restoration on the periodontium. In this
classic article they went on to decimate the then widely
held belief that overcontouring is permissible as it
apparently deflected the food bolus from the marginal
gingiva. They in fact opined that the cervical bulge
overprotected the microbial plaque and that the flatter
the contour was the lesser the plaque was retained.
They concluded by saying that the final restoration
should not follow the original anatomic crown but
should recreate the original contours of the root
portion. They advocated flattening of the cervical thirds
and fluting of the furcation region for better
accessibility for plaque control.www.indiandentalacademy.com

.In PFM atleast 1.5mm facial reduction is
required.
If the furcation has been exposed by
periodontal surgery or by recession it is
important that the restoration be contoured
in such a way as to facilitate access for oral
hygiene. In these cases it is necessary to
emphasize the mid facial grove of the crown
so that this groove is confluent with the
furcation.
Labial contours in anterior teeth :THE
EFFECT OF SURFACE FINISH OF
RESTORATIVE MATERIALS ON THE
PERIODONTIUM:

PONTICS
A pontic should meet the following
requirements: it should
(1) be aesthetically acceptable,
(2) provide occlusal relationships that are
favor-
able to the abutment teeth and opposing
teeth
and the remainder of the dentition,
(3) Restore the masticatory effectiveness
of the tooth it replaces,
(4) be designed to minimize accumulation
of irritating dental plaque and food debris
and to permit maximal access for cleansing

Plaque, which causes inflammation of the
mucosa under pontics and the gingiva
around abutment teeth, tends to
accumulate around fixed prostheses if a
special effort to keep them clean is not
undertaken. The health of the tissues
around fixed prostheses depends primarily
on the patient's oral hygiene; the materials
of which pontics are constructed appear to
make little difference, and pontic design is
important only to the extent that it enables
the patient to keep the area clean.

The tissue-facing surface should be kept
as convex as possible, and all concavities
should be eliminated
The bullet-shaped spheroidal pontic is the
most hygienic next to the sanitary type
.The proximal surfaces are tapered to
create spaces between adjoining pontics
for self-cleansing passage of food and
stimulation of the edentulous mucosa by
food excursion and for cleansing with
toothbrush and dental floss. Tapering
should also recreate spaces adjacent to
the abutment teeth that approach the
shape and dimension of the natural
embrasure to protect the marginal gingivawww.indiandentalacademy.com

In the posterior segments of the mouth,
the bullet-shaped pontic is the most
appropriate. In the anterior segments,
where aesthetics is a primary
consideration, the modified ridge-lap
design may be used. This pontic design
should have a convex surface on its
tissue-facing surface, and the tip of the
pontic should just barely contact the
edentulous mucosa.

The least damaging pontic design is the
sanitary or hygienic pontic. This pontic should
be designed so that there is at least a 3-mm
space between the undersurface of the pontic
and the edentulous ridge; this allows the
tongue and cheeks to remove any food
particles that may lodge in this area. It is often
necessary to use a design other than the
hygienic pontic for aesthetic reasons. Saddle-
type pontics, which straddle the ridge and have
a concave tissue-facing surface, have the
least desirable design and should be
avoided

RESTORATION OF MOLAR TEETH
WITH FURCATION INVASIONS:
Glickman’s classification:
Normal furcation: There is no bone or
attachment loss involving the furcation per
se or the flute leading into the furcation.
There may be early attachment loss and
pocket formation coronally but the flute
cannot be detected by with clinical probing
.
Grade I Involvement:
This is an incipient lesion. The pocket is
suprabony involving the soft tissue and
the flute concavity can be detected withwww.indiandentalacademy.com

Grade II Involvement:
This lesion is a cul de sac. Bone is
destroyed on one or more aspects of the
furcation but a portion of the alveolar bone
and the PDL remains intact permitting only
partial penetration of the probe into firca.
Grade III Involvement:
Interradicular bone is completely absent
horizontally but the entrance to the
furcation is occluded by the gingival tissue.

Grade IV Involvement:
The interradicular bone is completely
absent in a horizontal direction and the
gingival tissue has receded apically so that
the furcation is visible.

Tarnow and Fletcher’s sub classification:
Subclass A: 0-3mm probable depth from
the roof of furca
Subclass B : 4-6mm probable depth from
the roof of furca
Subclass C : 7mm or greater probable
depth from the roof of furca

Herbert E Ward in 1982 discussed the preparation of
furcally involved teeth. He discussed about three types
of tooth sectioning procedures viz., Resection of roots,
Hemisection and Bicuspidization, their indications and
the procedures involved. He concluded that
preparation of the sectioned tooth must be
accomplished with an adequate gingival margin and all
the portions of the tooth that were cut must be covered
by the cast restoration. He stressed the importance of
polished margins, smooth axial contours and wide
embrasures with occlusal harmony and meticulous
maintenance for the longevity of the restoration.

Root amputation: the removal of root from a
multirooted tooth
Root resection: surgical removal fo allor
portion of root before or after endodontic
treatment
Hemisection : Surgical separation of a
multirooted tooth through the furca in such
a way that a root, or roots may be surgically
removed along with the associated portion
of crown.
Splitting and retaining of roots: Bisection/
Trisection.

Excep
-tion
Generalized moderate/
severe boneless
Gr I, early Gr II/
Adv GrIV
Extensive non-
restorable fracture
not confined to
single root
Non restorable
caries involving
more than one root
Unfavorable
endodontic
prognosis for
more than one root
Fused roots
1.Moderate
hypermobility
2.Severe
hypermobility
1.Unfavourable root
morphology for
post-core
2.Inadequate tooth structure
to support crown
Bone support
Furcation
involvment
Fractured tooth
structure
Dental caries
Endodontic
considerations
Root
morphology
Mobility
patterns
Restorative
considerations
Severe vertical Bone loss
confined
to single root with adequate bone
support around remaining root(s)
Deep GrII,GrIII,
early GrIV
Vertical or horizontal
nonrestorable fracture
confined to single root
Nonrestorable tooth
confined to
single root
Favourable endod
- ontic prognosis
Well seperated
roots
Normalmobility
or slight
hypermobility
1.Favourable root morphology
for post-core
2.Adequate tooth structure to
support crown
Restorative recommen
-dation for tooth with
urcation involvment
Gr I,early
Gr II
Fluted complete
crown preprat
-ion with fluted
cast restoration
Deep GrII,GrIII,
early GrIV
1.Consider
root amputation
/hemisection
2. Consider
restoring
remaining tooth
structure with
post and core
Gr IV with
advanced
Vertical
bone loss
Poor
restorative
prognosis-
consider
oneretain
-ing one
root to supp
-ort anover
denture

Diagnosis and treatment planning flow chart for teeth with resected
roots
Condition of remaining teeth
Adequate support
for fixed unit
Inadequate support
for fixed unit
Plaque control measures
Scaling and root planning
Initial therapy evaluation
Vital root resection
during periodontal
Surgery.
EndodonticsEndodontic
therapy
Non vital
root resection
During periodontal
surgery
Roots resected
Healing phase
(4-6wks)
Dowel and core/
amalgam plug
Over denture abutment
Endodontic therapy
Completed in remaining
roots(3-4 wks)
stabilisation
Healing phase(4-6wks)
Dowel and core resorstion
Final restoration

When treating patients the objectives of restorative
therapy must be clear:
-Preservation of teeth
-Restoration of function
-Comfort
-Esthetics
The incorporation of all the above objectives may not
be always possible. In such cases it is well to
remember the fundamental precept of the health
professionals:
“DO NO HARM”.

References:
1.Tylman’s theory and practice of fixed prosthodontics:
W.F.P Malone, D.L. Koth, E. Cavazos, Jr, D.A Kaiser,
S.M Morgano, 8th
edition.
2.Contemporary fixed prosthodontics: Rosenstiel,
Land, Fujimoto, 3rd
edition.
3. Fundamentals of fixed prosthodontics: Herbert T.
Shilingberg, Sumiya Hobo, Lowell D. Whitsett, Richard
Joacobi, Susan E. Brackett, 3rd
edition.
4.Clinical periodontology: Carranza, Newman, 8th
edition.
5.Textbook of clinical periodontology: Jan Lindhe, 2nd
edition.

6.Ruel J. et al: Effects of retraction procedure on
periodontium of humans. J.Prosthet.Dent.1980 vol.44
pg.508-514
7.Dr.Sunil Kumar, Dr.N.P.Patil: Clinical evaluation of
different gingival retraction procedures and their
effects on gingival health (thesis) S.D.M.C.D.S.
8.Guy M. Newcomb: The relationship between thew
location of subgingival crown margins and gingival
inflammation. J Periodontol,1974pg.151-154

9.J. Gary Maynard, Richard Daniel, K. Wilson:
Phisiologic dimensions of the periodontium siginficant
to the restorative dentist. J Periodontol,1979 pg.170-
174
10. Ralph Yuodelis et al: Facial and lingual contours of
artificial complete crown restorations and their effects
on the periodontium. J Prosthet Dent, 1973,pg 61-66
11. Herbert E. Ward: Preparation of furcally involved
teeth. J.Prosthet Dent, 1982 pg 261-263

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Presentation1/ dental crown & bridge courses

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