Review article AODMR

Periodontal Considerations of Abutment Tooth

Ravishankar PL, Venugopal K1, Purnima V. Nadkerny2

Department of Periodontics, SRM Kattankulathur Dental College, SRM Nagar, Potheri.

(Kancheepuram Dt) Tamilnadu, India, 1Department of Periodontics, Sri Sai Dental College,
Srikakulam Andhra Pradesh, India, 2Department of Periodontics, New Horizon Dental
College, Bilaspur, Chattisgarh, India.

Address for Correspondence:

Dr. Ravishankar PL, Professor & Head, Department of Periodontics, , SRM Kattankulathur
Dental College, SRM Nagar, Potheri. (Kancheepuram Dt) Tamilnadu, India. Email:
[email protected]

ABSTRACT:
Glickman in 1948 reported that from the periodontal viewpoint, fixed prostheses are the
restorations of choice for replacement of missing teeth. But, sometimes removable partial
dentures could be the only choice of treatment. The success of a fixed partial denture depends
as much on the ability of the abutment teeth to sustain the stresses imposed upon them as on
the technical perfection of the prosthesis itself. Periodontal considerations, i.e., the type and
extent of the periodontal diseases, are of the first importance. The supporting periodontal
tissues surrounding abutment teeth must be healthy and free from inflammation before any
prosthesis can be contemplated. In view of above condition the operator needs a sufficient
knowledge of designing fixed partial denture as well as morphological and histological
features of supportive structure such as periodontium of abutment. Hence this study of the
literature has been taken up to understand the periodontal status both in health and detoriated
periodontal structure.

Keywords: Abutment, Fixed partial denture, Partial denture, Periodontium.

INTRODUCTION: structures, optimal base support, with

The success of fixed prosthodontic harmonious and functional occlusion.
restorations is largely dependent upon the
long-term health and stability of the PERIODONTAL CONSIDERATIONS:
surrounding periodontal structures. No One of the most important is patient oral
single restoration in dentistry is more hygiene. It is well suggested that the oral
dependent upon not influences more the hygiene of the patient must be assessed as
health of periodontal structures than the an important step in diagnosis and
full coverage restoration.1 treatment planning. Seeman in 1963
A partial denture should be constructed emphasized the need for establishment of a
with adequate abutment support, good satisfactory level of oral hygiene during
periodontal health to the remaining the treatment planning stage. The presence
of a partial denture may increase plaque

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formation around the remaining teeth, so bone to the base of the gingival sulcus.
oral hygiene must receive great emphasis (Figure 1)
in these patients. It is reasonably fair to
assume that the patient will do better in the
long term future than he has done in the
past. Therefore, before and after
constructing a partial removable
prosthesis, patient must be motivated and
maintained his remaining dentition with
good oral hygiene to preserve the integrity
of the periodontal health.
Another issue of partial design is to
determine the number of abutment teeth to Figure 1: Biological width
be used. Increase periodontal support can
be achieved with higher number of The design of preparation and the
abutment teeth. Multiple abutments reduce technique sensitive fabrication form one
injurious lateral and torsional stresses on side of the coin and establishing a
abutment teeth, and their use should be harmonious margin for a crown on
standard procedure in patients with abutment forms the other side of the coin
reduced periodontal support and those who when trying to insert a fixed prosthetic
are to receive removable partial dentures. restoration for replacing missing teeth, the
The clinician can make multiple abutments phenomenon of biological width was less
by connecting inlays or crown or crowns understood till very recently but the
or by clasping abutment and adjacent teeth growing clinical experience and better
in sequence. When the terminal tooth is diagnostic skills of today has helped us to
periodontally weak, more than one understand the intricacies of this concept
adjacent tooth should be added for and the need for its maintenance, the
adjacent support. Joining the weakened violation of which leads to the ultimate
tooth to a strong one is likely to weaken failure of the prosthesis. The health of the
the strong tooth as to strengthen the weak periodontal tissues is dependent on
one. It is always advisable to consider properly designed restorative materials.
whether the long-term interest of the Trauma to any portion of biological width
patient would be better served by causes gingival inflammation and
4
extracting the prospective weak abutment pockets. Overhanging restorations and
tooth and making a multiple abutment of open inter proximal contacts should be
two adjacent teeth that are relatively well addressed and remedied during the disease
supported.2,3 control phase of periodontal therapy
overdenture:
BIOLOGICAL WIDTH - NO 1. The presence of an adequate zone of
ENCROACHMENT ZONE: attached (keratinized) gingival around
The term biologic width refers to the these abutment teeth is critical importance.
combined connective tissue-epithelial 2. Any remaining residual periodontal
attachment from the crest of the alveolar defects must be treated in same way as

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they would be around any periodontally periodontium. Conversely, the healthy

involved tooth prior to the final periodontium is essential to the proper
restoration. function of the restoration.
Another advantage in the use of
overdenture regarding periodontally AVOID DEVITALIZATION OF PULP:
involved teeth is that it is possible to Limit tooth prep by using a narrow
improve the crown to improve the crown- chamfer preparation that includes only the
to-root ratio dramatically. This results in crown of the abutment tooth and not the
great diminution in the forces that are root.
applied to the remaining root.3 In gingival recession of an endodontically
treated posterior tooth with caries, the best
PERIODONTAL CONSIDERATION option for treatment is cast restoration that
AND ATTACHMENT LOSS: extends to the gingival margin of tooth.5
There is no evidence that periodontal
disease progresses more rapidly in older GENERAL PRINCIPLES:
people than in young adults. It is essential 1. Periodontal Health and clinical crown
that periodontitis is treated prior to the contour are interrelated.
placement of FPD. 2. If unavoidable, undercontouring is
There must be a continuous maintenance always preferable over overcontouring.
program adapted to patient’s ability to 3. Gradual and smooth curvatures should
maintain plaque control. Gingival be included in crown contour so as to
recession have technical consequences facilitate the rubbing and cleaning function
when treating patients with FPD. of the lips, cheeks and tongue.
The operator needs a sufficient knowledge 4. Contour of interproximal area should be
of designing fixed partial denture as well self cleansing and patient should be able to
as morphological and histological features clean them comfortably.
of supportive structure such as 5. Height of subgingival contour
periodontium of abutment. The marginal faciolingually should not be more than A
periodontium is where the fields of of the thickness of the gingival. This
prosthetic dentistry and periodontics protects the gingival crevice and also helps
overlap. This interdependence can be in maintaining knife like free gingival
understood only when there is agreement margin, with plaque control.
upon what constitutes a healthy marginal Regular oral assessments every three to
periodontium and how a pathological four months, Educate patients with regard
condition can be corrected and prevented. to the importance of good dental hygiene
A prosthetic procedure must be executed and symptom reporting.
carefully, especially in dentition with pre • Perform routine dental cleaning.
existing periodontal disease because of Management of periodontal disease is
these patients, often have an exaggerated necessary to prevent disease progression.
response to the slightest tissue insults. • Check and adjust dentures
Properly designed and created dental • Restorative care, not violating the
restorations provide functional stimulation biological width, may be performed.
and contribute to and support the

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• Tooth extractions should be considered study evaluated the degree of mobility of

last resort abutment teeth of distal extension and
• Non-surgical endodontics should be tooth supported removable partial dentures
avoided unless diagnosis of metastatic by using Periotest. Two types of clasp
disease necessitates such a procedure. design were selected for evaluation. In
• Implants and other elective procedures cases with unilateral and bilateral distal-
which penetrate through the mucosa and extension, a clasp design including a T
into bone are contraindicated. The least clasp of Roach retentive arm, a rigid
traumatic procedure should be performed reciprocal arm and a mesial rest were used.
to treat emergencies.6 For the abutments of tooth-supported
removable partial dentures, a second clasp
THE FINITE ELEMENT METHOD design with a cast circumferential buccal
(FEM): retentive arm, a rigid reciprocal clasp arm
For the first time an FE-model has been and a rest adjacent to the edentulous ridges
developed to analyze biomechanical was selected. A total of 68 abutment teeth
effects of masticatory loads in the equine was analysed. Periotest values were made
periodontal ligament under physiological at the time of denture placement (control)
conditions. The elaborated FE-models may and at 1, 3 and 6 months after the denture
allow designing continuative clinical placement. The results revealed that no
studies to analyze biomechanical effects of significant changes in tooth mobility were
chewing forces acting on the periodontal observed during the 6-months follow-up
ligament and on the dental hard tissues (P> 0.05). In conclusion, our findings
consequence is open spaces created suggest that adequate oral hygiene
gingival to the contract areas of the teeth.6 instructions, careful prosthetic treatment
The success of the therapy lies in the hands planning and regular recall appointments
of the clinician who must be totally play an important role in preventing
competent to render a comprehensive changes in abutment tooth mobility caused
diagnosis of the partially edentulous mouth by removable partial denture placement.8
and must plan every detail of treatment.
With careful preparation of the patient and Clinical Relevance to Interdisciplinary
accurate design and construction of the Dentistry
prosthesis, the dentist can preserve the • Fixed prosthetic treatments are always
longevity of the remaining dentition and dependent upon the support they receive
restoring the functional and comfort of the from abutment teeth. Abutment teeth
patient.7 should have sufficient coronal structure to
Prosthesis should be one of the means of provide retention to the prosthesis. It might
establishing conditions for the sometimes be necessary to expose or
maintenance of periodontal health. The increase the clinical crown by periodontal
forces applied to the abutment teeth and surgery for support and esthetics. It is also
their effects are very important seen that many a times the teeth are supra
considerations in the design and erupted as a result of absence of opposing
construction of the removable partial dentition which calls for the need of
dentures. A 6-month follow-up clinical intentional endodontic treatment. By a

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 Ravishankar et al: Abutment Tooth and its Periodontal Evaluation

combination of treatments with 3. Glickman I. The periodontal structures

interdisciplinary dentistry, we will succeed and removable partial denture prostheses. J
in providing a functional prosthesis which Am Dent Assoc 1948;37:311.
fulfils esthetic and restorative needs.9 4. Nevins M, Skurow HM. The
intracrevicular restorative margin, the
CONCLUSION: biologic width, and the maintenance of the
1. Restoration failure due to periodontal gingival margin. Int J Periodontics
breakdown can be minimized by following Restorative Dent 1984;4(3):30-49.
principle of contour design of crown. 5. Jiampolo JJH et al. Clinical evaluation
2. Interdental papillae health should be of abutment teeth of removable partial
given utmost importance. Sufficient care denture by means of the Periotest method.
should be given to design interdental space Journal of Oral Rehabilitation 2007;
in a way that it should be sufficiently 34:222-7.
protected. Placement of contact area 6. Jorgensen E. Prosthodontics for the
becomes critical in this regard. elederly, Quintessence Publishing Illinois
3. Facial and Lingual contour should be 1999.
made self protective and should help in 7. Mackerle J. Finite element modelling
self cleansing and avoiding food trap. and simulations in dentistry: a
4. Overcontouring of restoration has to be bibliography 1990-2003. Computer
avoided in every case. Methods in Biomechanics and Biomedical
5. Subgingival margin should be avoided. Engineering 2004;7:277-303.
But if placed, then sufficient attention 8. Dragoo MR, Williams GB. Periodontal
should be given to its contour so that it can tissue reactions to restorative procedures.
support the gingiva. Int J Periodobtics Restorative Dent
6. Contour of restoration should be such 1981;1(1):8-23.
that it should provide maximum cleansing 9. Prasad DK, Hegde C, Bardia A, Prasad
action. DA. Questionable abutments: General
7. With proper planning of restoration considerations, changing trends in
deign, not only esthetics but periodontal treatment planning and available options. J
health can be maintained. Interdiscip Dentistry 2013;3:12-7.

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