Currently, new materials and restorations may be finished easily to provide a smooth, polished interface at the gingival margin, so that plaque accumulation may be less. Įsthetics versus health is also a consideration since subgingival finish lines are not periodontally advantageous, although they are required in certain situations. This has also been reported for posterior crowns where bleeding was greater with sub-gingival crown placement. Twenty years later, Sorensen stated that subgingival margins greatly increase the frequency of periodontal disease, and that surface roughness, marginal fit and crown contour, mediate plaque accumulation and influence gingival health. Newcomb indicated that subgingival margins were associated with plaque accumulation and gingival inflammation. ![]() Many years ago, a clinician had three options for crown margin placement it could be supragingival, equigingival or subgingival. Synthetic crown margin placement, clinical crown size/length, crown contour and biological width are important etiological factors in gingival and periodontal health. A periodontal probe showed clinical crown length (Figure 4) and an intra-oral radiograph (Figure 5) confirmed, that the crowns were not placed at or adjacent to the cemento-enamel junction (CEJ), but markedly coronal to it, as one would expect if APE is not recognized. Clinical examination also showed the presence of APE which we have defined as "when a tooth has reached the occlusal plane and the gingival margin in the mid-line of the tooth is at the junction between the cervical and middle third of the clinical crown or in the middle third or coronal third of the clinical crown in the absence of inflammation, hypertrophy or hyperplasia of the gingiva". The associated gingivae were red, shiny with rolled margins and marked inflammation (Figure 4). Thereafter he was seen intermittently three years after the initial consultation he presented with synthetic crowns on the maxillary incisors, placed there by another practitioner. Possible gingival and periodontal surgical correction of the apparent gingival overgrowth was discussed with the patient who chose not to have this treatment. ![]() One week later, there was some resolution of the gingival inflammation (Figure 3).
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