Correspondence Address:
Vijendra P Singh
Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh
India

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Dear Editor,

I appreciate the editorial board of JID for publishing the good quality, clinically relevant scientific articles in their current issue, i.e. Jan-April 2012. In their invited review section, Dr Arvind Shenoy et al. [1] critically reviewed the "Periodontal considerations determining the design and location of margins in restorative dentistry". The article is well written, well covered, and the recent contribution from the literature is well reflected in it. This will help practicing dentists to make better informed decisions regarding the current techniques available for the location of margin in restorative dentistry.

The foundation for the gingival support is the underlying contour of the osseous crest. Bone gives tone, but it is the tissue which is always the issue. Certainly, apical margin of restoration is one of the most critical factors in ensuring a good gingival health and, in turn, successful restoration and esthetics. As no one method satisfies all the clinical requirements, clinicians should consider the pros and cons of each method, and planned restoration and esthetics for the individual patient, while at the same time preserving periodontal health.

We learn that biological width, which in natural teeth defines the distance between the most apical extent of the gingival sulcus and the crest of the alveolar bone, is the space occupied by gingival fibers, junctional epithelium, and connective tissue in direct contact with the tooth structure. This creates a natural seal around the teeth, protecting them from microbial invasion and traumatic insult. [2]

The morphologies of interdental papilla and the osseous architecture or housing the tooth can be categorized into two periodontal biotypes. The thin periodontal biotype is friable, escalating the risk of recession following crown preparation and periodontal or implant surgery. This is particularly significant for full coverage crowns for the following reasons. Firstly, the thin gingival margins allow visibility of a metal substructure (porcelain fused metal), thereby compromising esthetics in the anterior regions of the mouth. Secondly, due to the fragility of the thin tissue, delicate management is essential for avoiding recession, and hence visibility of subgingivally placed crown margins at the restoration-tooth interface.

The thick biotype is fibrotic and resilient, making it resistant to surgical procedures with a tendency for pocket formation (as opposed to recession). While the interdental gingival tissue possesses biological tissue memory, rebound of the gingival tissue is more likely in the thick periodontium than thin. Therefore, a thick biotype is more conducive for restoration placement, resulting in favorable esthetic outcomes. [3]

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