Section: Dentistry

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Biologic Width – Considering Periodontium in Restorative Dentistry

Mohammed Ahsan Razi1, Surangama Debnath2, Sourav Chandra3, Adreet Hazra4

describe the biologic width anatomy, categories, evaluation,

ABSTRACT violation, methods to correct the violation of biologic width
A satisfactory understanding of the relationship between and its relationship to periodontal health and restorative
periodontal tissues and restorative dentistry is supreme to dentistry.
safeguard satisfactory form, function, esthetics, and comfort
of the teeth and its supporting structures. The tooth and its
ANATOMY OF THE BIOLOGIC WIDTH
supporting structures shall be considered as one biologic unit. The dimension of the space that the healthy gingival tissue
Most of the dental surgeons are not aware of the important occupies the alveolar bone is called the biologic width.9
relationship, specific concepts such as biologic width, its [Figure 1] The term biological width was based on the work of
maintenance and applications of crown lengthening in cases Gargiulo et al., who described the dimensions and relationship
of biologic width violation. In the case of extensive caries, of the dento-gingival junction in humans. Measurements were
sub-gingival perforation and post and core placement in
done from the dento-gingival components of 287 individual
endodontic therapy, the concept of biologic width gains its
teeth from 30 autopsy specimens. Gargiulo et al established
importance. Biologic width is essential for the preservation
of periodontium, which ultimately decides the success of that there is a precise proportional relationship between the
restorative procedures. This article reviews the anatomy, alveolar crest, the connective tissue attachment, the epithelial
categories, evaluation, violation, methods to correct the attachment, and the sulcus depth. Gargiulo et al reported the
violation of biologic width and its relationship to periodontal following mean dimensions: A sulcus depth of 0.69 mm, an
health and restorative dentistry. epithelial attachment of 0.97 mm, and a connective tissue

Keywords: Biologic width, Crown lengthening, Periodontal

health, Restoration

INTRODUCTION
The concept of the biologic width (dentogingival unit) was
first commenced by a research conducted by Gargiulo,
Wentz, and Orban in which the distance between the apical
end of the gingival sulcus and the crest of the alveolar bone
was measured on several cadaver specimens.1,2 Later on, the
term 'biologic width' was introduced by Cohen to describe
the space over the tooth surface, occupied by the connective
tissue and epithelial attachments and this parameter being
equivalent to the distance between the bottom of the gingival
sulcus and the alveolar bone crest.3 The dentogingival unit
is important for the health of the gingiva, and invasion
Figure-1: Anatomy of biological width
on it may cause disruption and apical migration of the
attachment apparatus. The biological width is considered
to be essential for maintaining healthy gingiva, especially
1
Post Graduate Student, Department of Periodontology and Oral
in the case of teeth which needs restoration.4 Periodontal Implantology, 2Professor and Head, Department of Periodontology,
tissues form the main infra-structure for good esthetics,
3
Senior Lecturer, Department of Periodontology, 4Post Graduate
Student, Department of Periodontology, Hazaribag College of
proper functioning, and comfort of the dentition.5 Biological
Dental Sciences and Hospital, Demotand, Hazaribag, Jharkhand,
width acts as a barrier to prevent entry of microorganisms
India.
into the periodontium.6 Satisfactory understanding of the
relationship between periodontal tissues and restorative Corresponding author: Mohammed Ahsan Razi, Department
dentistry is necessary to ensure adequate form, esthetic and of Periodontology, Hazaribag College of Dental Sciences and
functions, and comfort of the dentition.7 If there is restoration Hospital, Demotand, Hazaribag, Jharkhand. PIN- 825301, India
of a tooth without considering biological width, it results
How to cite this article: Mohammed Ahsan Razi, Surangama
in poor periodontal response and failure of restoration.8 Debnath, Sourav Chandra, Adreet Hazra. Biologic width –
Many clinicians are not unable to utilize the concept of Considering periodontium in restorative dentistry. International
biologic width in a practical manner even though there is Journal of Contemporary Medical Research 2019;6(3):C5-C11.
an increased emphasis on the perio-restorative interface in
restorative dentistry.8 Hence, the purpose of this paper is to DOI: http://dx.doi.org/10.21276/ijcmr.2019.6.3.15

International Journal of Contemporary Medical Research C5

ISSN (Online): 2393-915X; (Print): 2454-7379 | ICV: 98.46 | Volume 6 | Issue 3 |March 2019
Section: Dentistry
Razi, et al. Biologic Width – Considering Periodontium in Restorative Dentistry

attachment of 1.07 mm. Based on this, the biologic width is is very easy.
commonly stated to be 2.04 mm, which represents the sum 3. Duplication of the margins with impressions that past
of the epithelial and connective tissue measurements.9 In the finish line without damage or deformation is the
1977, Ingber et al. described "Biologic Width" and credited easiest with supragingival margins.
D Walter Cohen for first coining the term.10 The dimension 4. Finishing and fitting of the restoration and removal of
of biologic width is not constant always, it depends on the excess material are easiest.
area of the tooth in the alveolus, differ from tooth to tooth, 5. There is the least irritation to the periodontal tissue.
and also from the appearance of the tooth. It has been shown Equigingival margin
that 3 mm between the preparation margin and alveolar bone Due to the thought that equigingival margin favours more
maintains periodontal health for 4 to 6 months.11 This 3 mm plaque accumulation than supragingival or subgingival
aggregate on an average for supra-crestal connective tissue margins, and therefore result in greater gingival inflammation,
attachment (1 mm), junctional epithelium (1 mm) and for equigingival margins was traditionally not desirable. There
gingival sulcus (1 mm). This allows for adequate biologic was also the matter, an even minor gingival recession would
width even when the restoration margins are placed 0.5 create an unslightly margin display. Now these concerns
mm within the gingival sulcus.12 According to Nevins and are not valid today, because the restoration margins can be
Skurow when subgingival margins are indicated, the dentist esthetically integrated with the tooth and restorations can
should not disrupt the junctional epithelium or connective be finished easily to provide a smooth, polished interface
tissue apparatus during tooth preparation and during at the gingival margin. From a periodontal viewpoint, both
impression taking. According to the authors, subgingival supragingival and equigingival margins are well tolerated.7
margin extension should be limited to 0.5-1.0 mm because
violating this, it is impossible for the clinician to detect where Subgingival margin
the sulcular epithelium ends and the junctional epithelium Due to caries or any tooth deficiencies, and/or to mask the
begins.13 tooth/restoration interface, restorative considerations will
periodically dictate the placement of restoration margins
MARGIN PLACEMENT AND BIOLOGIC WIDTH beneath the gingival tissue crest. Forced entrance into biologic
According to Ingber et al., (1977) there is a requirement of periodontal space by clinicians for additional retention
minimum 3mm from the restorative margin to the alveolar will lead to iatrogenic periodontal disease with early loss
crest for an adequate healing and restoration of the tooth.10 of restoration. If the restoration margin is placed far away
Maynard and Wilson in 1979 divided the periodontium into below the gingival tissue crest, restoration will impinge on
three-dimensions, a) Superficial physiologic: Representing the gingival attachment which leads to inflammation which
the free and attached gingival surrounding the tooth. is worsened by the patient's as they are unable to clean this
b) Crevicular physiologic: Representing the gingival area. Many Investigators have correlated that sub gingival
dimension from the gingival margin to the junctional restorations promotes more qualitative and quantitative
epithelium. c) Sub-crevicular physiologic: consisting of changes in the micro flora, increased plaque index, increased
the junctional epithelium and connective tissue attachment. gingival index, increased pocket depth, increased recession
This sub crevicular physiologic dimension is analogous and increased gingival fluid.15,16
to the biologic width described (Gargiulo et al. 1961), EVALUATION OF BIOLOGIC WIDTH VIOLATION
These all three dimensions have influence in making
a) Clinical method
decisions during restorative phase.14 From the alveolar
If a patient experiences or complains of tissue discomfort
crest to the crown margin a minimum 3.0 mm distance is
when the margin levels of restoration are being determined,
necessary.13
with the help of suitable periodontal probe, indicating that
A clinician has three options for margin placement: i)
the margin extends into the attachment leading to biological
Supragingival, ii). Equigingival, and iii) subgingival
width violation. During restorative preparation, if the apical
locations
margin is placed within the biologic width (i.e., too close
Supra-gingival margin to the bone), there is likely to develop a zone of chronic
It has the least impact on the periodontium. Due to the inflammation. There is also bleeding on probing, localized
marked contrast in opacity and color of traditional restorative gingival hyperplasia with a minimal bone loss, pocket
materials against the tooth, the margin location has been formation, gingival recession clinical attachment loss and
applied in areas where aesthetics are not required. Nowadays alveolar bone loss, the sign of biological width violation.11
with the advent of more translucent restorative materials and One of the theories proposed is that there is meager space
resin cements, there is more ability to place supragingival for a “normal” length of junctional epithelium to develop;
margins in esthetic areas.7 the junctional epithelium is short, fragile, and does not exert
Advantages of supragingival margin11 a proper sealing effect of the dentogingival unit.17 The area
1. Preparation of the tooth and finishing of the margin is is easily impaired by mechanical oral hygiene practices,
effortless. the chronic inflammation is readily induced or may persist.
2. Authentication of the marginal integrity of the restoration Other authors believe that if the subgingival restorative

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Razi, et al. Biologic Width – Considering Periodontium in Restorative Dentistry

Section: Dentistry
margin is deeply placed i.e., close to the crest of alveolar CATEGORIES/PROFILES OF BIOLOGIC WIDTH
bone, prejudice (impairs / hampers) the maintenance of TO PREVENT BIOLOGIC WIDTH VIOLATION
proper plaque control, promoting certain inflammatory Based on the total dimension of attachment and the sulcus
changes which are not good to a healthy periodontal depth following bone sounding measurements, Kois
environment.18 Subgingivally placed restoration margins proposed three categories of biologic width namely:
and gingival hyperplasia is most frequently found in altered 1) Normal Crest, 2) High Crest and, 3) Low Crest.21,22 [Figure
passive eruption.11 2] [Table 1]
Bone sounding: Normal crest patient
The level of the alveolar crest must be determined preceding to It occurs in almost 85% of patients. 3.0 mm is the mid-facial
any considerations regarding aesthetic crown lengthening so measurement and the proximal measurement is in the range
as to determine the feasibility, surgical aspects, and treatment of 3.0-4.5 mm. The margin of a crown shall generally be
sequence. The biologic width can be done following the placed no closer than 2.5 mm from the alveolar bone. In this
administration of a local anesthesia, a measuring instrument the gingival tissue seems to be substantial for a long term.
(probe) is utilized to puncture and penetrate the mucosa Therefore, a crown margin which is placed 0.5 mm sub-
until contact is made with the underlying bone (referred to gingivally tends to be well-tolerated by the gingiva in such
as "sounding to the bone") and subtracting the sulcus depth patients.8
from the resulting measurement. If this distance is less than High crest patient
2 mm at one or more locations, biologic width violation may High Crest is a rare finding and occurs in approximately
be confirmed. This measurement should be performed on the 2% of the patients. This is seen mostly in a proximal
teeth having healthy gingival tissues and should be repeated surface adjacent to an edentulous site due to the collapse of
on more than one tooth to ensure accurate assessment, and interproximal papilla following tooth removal. Usually, it is
reduce individual and site variations. During this periodontal not possible to place an intra-crevicular margin because the
evaluation, bone sounding assists in determining the level of margin will be very close to the alveolar bone, resulting in a
the alveolar crest and thus the need for osseous contouring10,19 breach of biologic width that will eventually lead to chronic
b) Radiographic evaluation inflammation. The mid-facial measurement is > 3.0 mm and
Radiographic interpretation can be very helpful to the the proximal measurement is also >3.0 mm.8
clinicians in identifying interproximal violations of biologic Low-crest patient
width. However, radiographs are not diagnostic on the mesio- It occurs in almost 13% of patients. Generally, the Low Crest
facial and disto-facial line angles of teeth, because of tooth patient has been illustrated as more vulnerable to recession
superimposition.20 H. Sushama and Gouri have described secondary to the placement of an intra-crevicular crown
a new innovative, parallel profile radiographic (PPR) margin.
technique to measure the dimensions of the dento gingival When retraction cord is placed consecutive to the crown
unit (DGU). The authors assume that the PPR technique preparation; the attachment apparatus is frequently injured.
could be used to measure both length and thickness of the As there is healing of injured attachment apparatus, it tends
DGU with accuracy, as it was simple, concise, non-invasive, to alleviate back to a normal crest position that ultimately
and a reproducible method.19 results in gingival recession. The mid-facial measurement

Normal Crest High Crest Low Crest

Mid‑facial measurement 3 mm <3 mm >3 mm
Proximal measurement 3‑4.5 mm <3 mm >4.5 mm
Table-1: Dimensions of attachment and sulcus depth following bone sounding.

Figure-2: Categories of biological width

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Section: Dentistry
Razi, et al. Biologic Width – Considering Periodontium in Restorative Dentistry

is < 3.0 mm and the proximal measurement is <4.5 mm.8 b) Orthodontic Extrusion
All low crest patients do not react in an equivalent way to a) Surgical Crown Lengthening: [Fig.3]
an injury to the attachment as some low crest patients are Indications for Surgical crown lengthening25
prone to gingival recession while others have a quite stable 1. Inadequate clinical crown for retention due to large
attachment apparatus, depending on the depth of the sulcus.23 caries, sub-gingival caries or fracture of the tooth,
IMPORTANCE OF DETERMINING THE CREST perforations in root or root resorption within the cervical
1/3rd of the root in teeth with adequate periodontal
CATEGORY
attachment.
When preparing anterior teeth for indirect restorations, it 2. Restorations which violate the biologic width.
is must for the clinicians to know in detail about the Crest 3. Placement of sub gingival restorative margins.
category. Determination of the crest category allows the 4. Short clinical crowns.
clinicians to determine the excellent position of margin 5. Teeth with excessive occlusal wear or incisal wear.
placement. It also helps the clinician to inform the patients 6. Teeth with inadequate inter occlusal space for proper
of the probable long-term effects of the crown margin on restorative procedures due to supraeruption.
gingival health and esthetics.8 If the sulcus is in the deeper 7. Unequal, excessive, or unesthetic gingival levels for
range, the clinicians can forecast that an intra-crevicular esthetics.
crown margin placed in this unstable low-crest patient would 8. In conjunction with tooth requiring hemisection or root
result in the gingival recession. However, if the sulcus is in resection.
the shallow range, the clinician may treat this stable low- Contraindications for Surgical crown lengthening 25
crest patient like a Normal-Crest patient. An intra-crevicular If there is need of excessive bone removal in case of deep
margin can be placed with a feasible intention of long-term caries or fracture.
stability and esthetics.8,10,19,20 1. Tooth with an increased possibility of furcation
Based on the sulcus depth the following three rules can be involvement.
used to place intra-crevicular margins: 2. Unaesthetic outcomes after Post-surgery.
a) If the probing depth of sulcus is 1.5 mm or less, the 3. Non-restorable teeth.
restorative margin can be placed 0.5 mm below the 4. Unreasonable compromise of esthetics
gingival tissue crest. 5. Tooth with inadequate crown root ratio (2: 1 ratio is
b) If the probing depth of sulcus more than 1.5 mm, the preferred ideally).
restorative margin should be placed in half the depth of 6. Unreasonable compromise on adjacent alveolar bone
the sulcus. support.
c) If the probing depth of sulcus is greater than 2 mm,
gingivectomy may be executed to lengthen the tooth and CROWN LENGTHENING PROCEDURES [FIG 4]
create a 1.5 mm sulcus.21,24 After performing an analysis of the individual case with
concern to crown-root alveolar bone relationships, the proper
CORRECTION OF BIOLOGIC WIDTH
treatment approach for crown lengthening is decided. The
VIOLATION
proper treatment approach for crown lengthening procedures
Biologic width violations can be reformed by either are as follows:
surgically removing bone away from proximity to the 1) External bevel gingivectomy: Gingivectomy is a very
restoration margin, or by applying orthodontic forces, successful and anticipated surgical procedure done for
extruding the tooth, thus moving the margin away from reconstruction of biologic width; however, it can be only
the bone. Correction of Biologic Width Violation can be used in situations with hyperplasia or pseudo pocketing
achieved by two methods: (> 3 mm of biologic width) and presence of adequate
a) Surgical Crown Lengthening amount of keratinized tissue. When attached gingiva is

Figure-3: Surgical crown lengthening

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Razi, et al. Biologic Width – Considering Periodontium in Restorative Dentistry

Section: Dentistry
Figure-4: Explanation of Crown Lengthening

length in a scalloped fashion, and for following the

desired contour of the overlying gingiva. As a general
rule, at least 4 mm of sound tooth structure must be
exposed, because soft tissue will proliferate coronally
to cover 2-3 mm of the root so that leaving only 1-2
mm of supra-gingivally located sound tooth structure.
Complications after crown lengthening can be Poor
esthetics (black triangles), Root hypersensitivity, root
resorption and transient mobility.27,28
Orthodontic procedures
Orthodontic extrusion can be performed in two ways [Fig.
5]29
Figure-5: Orthodontic Extrusion Slow
This is done by applying low orthodontic force, the tooth
more than adequate and there is no bone involvement, in eruption is slow, bringing the alveolar bone, and gingival
such case method of eliminating excessive pocket depth tissue along with it. The tooth is extruded until the bone level
and or of exposing additional coronal tooth structure is has been drifted coronal to the optimal level by the amount
done by external-bevel gingivectomy.26 that needs to be removed surgically for correcting the
2) Internal bevel gingivectomy: For reduction of excessive biologic width violation. Stabilization of the tooth is done
pocket depth and for exposing additional coronal tooth in this position and then treated with appropriate surgical
structure in the absence of a sufficient zone of attached procedures to correct the bone and gingival tissue levels.
gingiva (with or without the need for correction of
osseous abnormalities) requires a surgical procedure, in Rapid The tooth is erupted to the desired amount for several
which the flap must always be internally beveled so as to weeks (with supracrestal fibrotomy performed weekly in an
expose the supporting alveolar bone.7 intentional to prevent the tissue and bone from succeeding
the tooth).Then the tooth is stabilized minimum for 12 weeks
APICAL REPOSITIONED FLAP SURGERY
prior to surgical correction.
It is indicated in the crown lengthening of multiple teeth in
Forced tooth eruption
a quadrant. Apical repositioned flap surgery should never be
Heithersay and Ingber were the first to suggest the use of
used during surgical crown lengthening of a single tooth in
"forced eruption" to treat "non-restorable" or previously
the esthetic zone.
"hopeless" teeth.30 Forced tooth eruption should be done in the
Apical repositioned flap surgery can be done by following
cases where conventional crown lengthening via ostectomy
methods:
cannot be achieved as in anterior area, as ostectomy will lead
a) Apically repositioned flap without osseous resection:
to a negative architecture, and there is also a removal of bone
This procedure is done when there is a biologic width
from the adjacent teeth which can eventually compromise
of more than 3 mm on multiple teeth, and there is no
the function of these teeth. Forced tooth eruption is
adequate width of attached gingiva.
b) Apical repositioned flap with osseous reduction: This contraindicated where there is an inadequate crown-to-root
technique is used when biologic width is less than 3 ratio, lack of occlusal clearance for the required amount of
mm, there is no adequate zone of attached gingiva. The eruption and possible periodontal complications.31
alveolar bone is reduced by the process called ostectomy Techniques of forced tooth eruption
followed by osteoplasty, to expose the required tooth Orthodontic brackets are bonded to the affected tooth and

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Section: Dentistry
Razi, et al. Biologic Width – Considering Periodontium in Restorative Dentistry

adjacent teeth and are combined with the help of an arch Center; 1962.
wire. Power elastic is tied from the bracket to the arch wire 4. Carranza's Clinical Periodontology. In: Spear FM,
which pulls the tooth coronally. Cooney JP, Editors. 10th ed. St. Louis, Missouri:
Starr, gave two concepts of forced eruption: Forced eruption Elsevier Publications; 2006:chapter 72, 1052
5. Padbury Jr A, Eber R, Wang HL. Interactions between
with minimal osseous resection, and forced eruption
the gingiva and the margin of restorations. J Clin
combined with fibrotomy. Frank et al. described forced
Periodontol 2003;30:379-85.
eruption of multiple teeth.32 Fibrotomy is performed with a 6. Luis Antonio Fellippe, Monteiro Jr, Luis Clovis, Cardoso
scalpel at 7-10 day intervals to detach the supracrestal fibers Viera, Elito Araujo. Reestablizing biologic width with
so that preventing the crestal bone form following the root forced eruption. Quitessence Int 2003;34:733-8.
in a coronal direction. Fibrotomy in case of forced tooth 7. Khuller N, Sharma N. Biologic width: Evaluation and
eruption the crestal bone, and the gingival margin are restored correction of its violation. J Oral Health Co mm Dent
at their pre-treatment location. The tooth gingiva interface 2009;3:20-5.
at adjacent teeth is unaltered.33 Forced tooth eruption with 8. Robbins JW. Tissue management in restorative dentistry.
fibrotomy is contraindicated in angular bone defects and Funct Esthet Restor Dent 2007;1:40-3
9. Gargiulo AW, Wentz FM, Orban B. Dimensions and
ectopically erupted teeth.
relations of the dentogingival junction in humans. J
CONCLUSIONS Periodontol 1961;32:261-7.
The overall health of periodontal tissue is solely dependent 10. Ingber JS, Rose LF, Coslet JG. The "biologic width"-a
concept in periodontics and restorative dentistry. Alpha
on properly designed restoration. Incorrectly placed
Omegan 1977;70:62-5.
restorative margins and poorly adapted restorations violate 11. Jorgic-Srdjak K, Plancak D, Maricevic T, Dragoo
the biologic width. Properly designed restorations play a MR, Bosnjak A. Periodontal and prosthetic aspect of
vital role in maintaining the overall health of the periodontal biological width part I: Violation of biologic width.
tissues. Incorrectly positioned restoration margin and Acta Stomatol Croat 2000;34:195-7.
improper restoration violate the biologic width. Clinicians 12. Rosenberg ES, Cho SC, Garber DA. Crown lengthening
regularly encounter cases in daily practice such as extensive revisited. Compend Contin Educ Dent 1999;20:527.
caries, subgingival perforation and post and core placement 13. Nevins M, Skurow HM. The intracrevicular restorative
in endodontic therapy, fractured teeth etc. In this type margin, the biologic width, and the maintenance of the
of cases concept of biologic width gain its importance. gingival margin. Int J Periodont Restor Dent 1984;4:30-
49.
Clinicians should be aware of the important relationship,
14. Maynard JG Jr, Wilson RD. Physiologic dimensions of
specific concepts such as biologic width, its maintenance and
the periodontium significant to the restorative dentist. J
applications of crown lengthening in cases of biologic width Periodontol 1979;50:170-4
violation. Biologic width is essential for the preservation 15. Valderhaug J, Birkeland JM. Periodontal conditions in
of periodontium which ultimately decides the success of patients 5 years following insertion of fixed prostheses.
restorative procedures. Patient cooperation, motivation Pocket depth and loss of attachment. J Oral Rehabil
and regular maintenance visits, plays an important role in 1976;3:237-43.
the success of restorations and maintenance of periodontal 16. Newman, Takei, Klokkevold, Carranza's Clinical
health. Periodontology. 10th ed. Philadelphia: Saunders,
Elsevier Publishing; 2006. p. 1050-69.
ACKNOWLEDGEMENTS 17. Schroeder HE, Listgarten MA, Fine structure of the
Authors would like to thank Dr. Rajvir Malik Ex-Head developing epithelial attachment of human teeth.
of the department of Periodontology, Hazaribag college Monogr Dev Biol 1971;2:1-134
of Dental Sciences and Hospital, Hazaribag, Jharkhand 18. Holmes JR, Sulik WD, et al, Marginal fit of castable
ceramic crown. J Prosthet Dent 1992; 67:594-9
for their valuable suggestions. Authors would also like to
19. Kois JC. Altering gingival levels: The restorative
thank Dr. Bimlesh Kumar, Senior Lecturer, Department of
connection. Part I: Biologic variables. J Esthet Dent
Orthodontics, Hazaribag college of Dental Sciences and 1994;6:3-9.
Hospital, Hazaribag, Jharkhand for helping us in performing 20. Galgali SR, Gontiya G. Evaluation of an innovative
orthodontic extrusion. Authors would also like to thanks Dr. radiographic technique- parallel profile radiography-
Seema Qamar, Dr. Rabia Zarrin and Dr. Akansha Srivastava to determine the dimensions of the dentogingival unit.
for help in drawing pictures. Indian J Dent Res 2011;22:237-41.
21. Kois JC. The restorative-periodontal interface:
REFERENCES Biological parameters. Periodontol 2000. 1996;11:29-
1. Cohen DW, Current approaches in periodontology. J 38
Periodontol 1964; 35:5-18 . 22. Robinson PJ, Vitek RM. The relationship between
2. Gargiulo AW, Wentz FM, Orban B, Dimensions and gingival infla mmation and the probe resistance. J
relations of the dentogingival junction in humans. J Periodontal Res 1975;14:239-43
Periodontol 1961; 32:261-7. 23. Vacek JS, Gher ME, Assad DA. The dimensions of the
3. Cohen DW. Pathogenesis of periodontal disease and its human dentogingival junction.Int J PeriodontRestor
treatment. Washington DC: Walter Reed Army Medical Dent 1994;14:154-65

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Razi, et al. Biologic Width – Considering Periodontium in Restorative Dentistry

Section: Dentistry
24. Freeman K, Bebermeyer R, Moretti A, Koh S. Single-
tooth crown lengthening by the restorative dentist: A
case report. J Greater Houston Dent Soc 2000;2:14-6
25. Jorgic-Srdjak K, Dragoo MR, Bosnjak A, Plancak D,
Filipovic I, Lazic D. Periodontal and prosthetic aspect
of biological width part II: Reconstruction of anatomy
and function. Acta Stomatol Croat 2000;34:441-4.
26. Smukler H, Chaibi M. Periodontal and dental
considerations in clinical crown extension: A rationale
basis for treatment. Int J Periodont Restor Dent
1997;17:464-77.
27. Pontoriero R, Carnevale G. Surgical crown lengthening:
A 12- month clinical wound healing study. J Periodontol
2001;72:841-8.
28. Elavarasu S, Kermani K, Thangakumaran S,
Jeyaprakash GS, Maria R. Apically repositioned flap in
reconstruction of mutilated teeth. JIADS 2010;1:63-6.
29. Parashar A, Zingade A, Samitop S, Gupta S, Pareshar
S. Biologic width. The silent zone. Int Dent J Stud Res
2015;2:4-13.
30. Durham T, Goddard T, Morrison S. Rapid forced
eruption: A case report and review of forced eruption
techniques. Gen Dent 2004;48:167-75.
31. Wise MD. Stability of the gingival crest after surgery
and before anterior crown placement. J Prosthet Dent
1985;53:20-3
32. Smukler H, Chaibi M. Periodontal and dental
considerations in clinical crown extension: A rationale
basis for treatment. Int J Periodont Restor Dent
1997;17:464-77.
33. Felippe LA, Monteiro Júnior S, Vieira LC, Araujo E.
Reestablishing biologic width with forced eruption.
Quintessence Int 2003;34:733-8.

Source of Support: Nil; Conflict of Interest: None

Submitted: 01-02-2019; Accepted: 05-03-2019; Published: 16-03-2019

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