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3. Acrylic provisionals should be placed with
Durelon (3M ESPE ; St. Paul, MN) temporary
cement. Durelon is antimicrobial and helps
decrease sensitivity.
4. Remove provisional at time of surgery for
access. Ideally, a mosquito forcep is used with
a gentle rock at the incisal third of the occlusal
surface of the provisional.
5. Shape the tooth surface and remove old
margin, as well as 360 degrees of CEJs. A
flat-ended bur with a 4-degree taper is best for
biologic shaping. A diamond grit is best.
6. Correct any reverse architecture and remove
any necessary bone where biologic width
issues are still present. The goal is to create an
osseous contour identical to the soft tissue
contours that take place when forming a new
biologic width.
Figure 2: With the provisional removed, the surgeon now has
the ability to treat the tooth vertically.
7. Add sufficient connective to protect the bone
from bacterial infiltration. The co-nnective also
protects underlying periodon-tal tissues from
impression material and cementation irritation.
8. Once the flaps are adapted using 5-0 chromic
gut suture just coronal to the osseous support,
potassium oxalate should be used to help
decrease sensitivity. The liquid is applied to the
root surface for 45 to 60 seconds and then
lightly air-dried. Repeat two to three times.
Figure 3: The depth of the margins can be seen with inflammation
noted on the distal of tooth #19.
Figure 1: Biologic width violation along with a severe inflammatory
response.
Figure 4: A split thickness flap is retracted to see the underlying
defects and location of the existing margin. Note the
reverse architecture present and close location of the existing
margin to the bone.
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