Relationship between periodontics and restorative procedures: surgical treatment of the restorative alveolar interface (rai)--case series

Abstract

Maintenance of a healthy periodontium is fundamental for the long term success of prosthetic restorations. Thus, prosthetic procedures with subgingival margins may affect the periodontal health if the distances between the junctional epithelium and supracrestal connective tissue attachment aren't respected, or if there is insufficient space to maintain the health of the interproximal tissues, leading to gingival inflammation, connective tissue attachment loss and bone resorption. The restorative alveolar interface (RAI) technique was described as the portion of the root surface extending from the alveolar crest apically to the restorative margin coronally. RAI consists of modifying the restorative margin position into a healthier environment, respecting the biological width and therefore allowing effective plaque control. This paper describes four clinical cases with indication for the RAI technique for maintenance of periodontal health. The cases were associated with prostheses. All cases were evaluated at 90 days and exhibited a healthy periodontal tissue. Successful outcomes were observed in the different indications for the RAI technique.

Keywords: Gingival health; Periodontal; Prosthetic; Restorative dentistry.

Fig. 1

a Buccal view after tooth preparation and cementation of provisional restorations. b Presence of gingival inflammation. c Root proximity of the lateral incisor and canine. d Buccal view of intrasulcular incision to raise a full-thickness flap and inflammatory tissue debridement, and buccal view after root reduction and planing with a #3203 diamond bur and curettes. e Buccal view of the suture. f Buccal view after a 30 day control period. g Occlusal view of 90 day postoperative control. h Clinical aspect of the ceramometal crown

Fig. 2

a Gingival inflammation and root proximity of the second premolar and first molar. b RAI management reducing root proximity. c Occlusal view of suture. d 90 day control

Fig. 3

a Extensive amalgam restoration. b Removal of the fractured palatal cusp. c Flap elevation exposing the preparation margins and bone crest. Note invasion of the biological width at the distal aspect of the second premolar and mesial aspect of the first molar. d Reestablishment of biological distances with root planing (RAI). e After RAI. f 15 day control showing minimal swelling. g 3 month postoperative control

Fig. 4

a Buccal view of hypodontia of the lateral incisor. b Full-thickness flap. c RAI management. Root reduction and distal planing of canine with a #3203 diamond bur. d Root reduction and mesial planing of canine with a #3203 diamond bur. e 90 day control––the canine was transformed into lateral incisor in order to reestablish the esthetics and function