BIOLOGIC

WIDTH
Dr rohit rai
 CONTENT
• Definition
• Video representation of biologic width
• Biologic width evaluation
• Correcting biologic width violation
• Margin placement and biologic width
• Biologic width concept & dental implant
 DEFINITION
• Biological width is defined as the physiologic dimension of the
junctional epithelium & connective tissue attachment.
• The dimension of space that the healthy gingival tissue occupy
above the alveolar bone is now identified as the biologic width.
• The term biologic width is used to describe the junctional
epithelium and connective tissue that attach to the root surface.
• This term was based on the work of Gargiulo et al (1961).
• In average human the connective tissue
attachment occupies 1.07mm of space above
the crest of the alveolar bone & junctional
epithelial attachment below the base of the
gingival sulcus occupies another 0.97mm of
space above the connective tissue attachment.

• The combination of these two measurements

constitutes the biologic width.
(Gargiulo1961)
• The dimension of biologic width is not
constant, it depends on the location of the
tooth in the alveola, varies from tooth to tooth,
and also from the aspect of the tooth.Its
constancy (is only one - it) can only be found
in healthy dentition.

• There is a problem in determining biologic

width. It does exist, but clinically, it is
impossible to define.
• If the gingiva looks healthy, and does not
bleed on probing, one can suspect that the
histologic sulcus (which has been destroyed
while probed) of such a healthy or treated
tooth was approximately 0.5 mm deep.
• This means that the margin of a restoration
may not be put more than 0.5 mm
subgingivally.
• With this in mind, all requirements for the
maintenance of periodontal health can be
established.
 When are to consider
• Extensive caries( class II,III,V)
• Crown and/or Root fracture
• Subgingival perforation
• Orthodotic banding
• Subgingival margin placement
• Endodontically treated tooth with post and
core
 BIOLOGICAL WIDTH EVALUATION
• The biologic, or attachment, width can be
identified for each individual patient by probing
under anaesthesia to the bone level (referred to as
“sounding to bone”) and subtracting the sulcus
depth from the resulting measurement.
• This measurement must be performed on teeth
with healthy gingival tissues and should be
repeated on more than one tooth to ensure an
accurate assessment.
• Radiographic
interpretation can
identify interproximal
violations of biologic
width.
• However, with the
more common locations
on the mesiofacial and
distofacial line angles
of teeth, radiographs
are not diagnostic
because of tooth
superimposition
 CORRECTING BIOLOGIC WIDTH
VIOLATIONS
• Can be corrected by—
1.surgically removing bone
2.orthodontic extruding the tooth

• Surgery is the more rapid of the two treatment option.

• In this situations the should be moved away from the
margin by measured distance of the biologic width
for that patient, with an additional 0.5mm of bone
removed as safety zone.
Bone removed to created biologic width, 3.0 mm
 Ramifications of a biologic
width violation if a
restorative
margin is placed within the
zone of the attachment. On
the
mesial of the left central,
bone has not been lost, but
gingival inflammation
occurs. On the distal of the
left central, bone loss has
occurred and a normal
biologic width has been
reestablished.
Gingival recession is a potential risk after
removal of bone
• If interproximal bone is removed, there is a
high likelihood of papillary recession and the
creation of an unaesthetic triangle of space
below the interproximal contacts.

• if the violation is across the facial surface and

the gingival tissue level is correct, then
orthodontic extrusion is indicated.
• The extrusion can be performed in two ways.
1.Low orthodontic extrusion force
2. Rapid orthodontic extrusion

• By applying low orthodontic extrusion force,

the tooth is erupted slowly, bringing the
alveolar bone and gingival tissue with it.
 Rapid canine
retraction and
orthodontictratment
courtsy-
Am j orth dent
orthoped
2007;127(1):533-
541
• The tooth is extruded until the bone level has
been carried coronal to the ideal level by the
amount that needs to be removed surgically to
correct the attachment violation.

• The tooth is stabilized in this new position and

then treated with surgery to correct the bone
and gingival tissue levels.
• Another option is to carry out rapid
orthodontic extrusion whereby the tooth is
erupted the desired amount over several
weeks.
• During this period, a supracrestal fibrotomy is
performed weekly in an effort to prevent the
tissue and bone from following the tooth.
• The tooth is then stabilized for at least 12
weeks to confirm the position of the tissue and
bone,and any coronal creep can be corrected
surgically.
Margin Placement and Biologic Width
• Restorative clinicians must understand the
role of biologic width in preserving healthy
gingival tissues and controlling the gingival
form around restorations.
• They must also apply this information in the
positioning of restoration margins, especially
in the esthetic zone where a primary
treatment goal is to mask the junction of the
margin with the tooth.
• A clinician is presented with three options for
margin placement:
1. supragingival
2.equigingival
3.subgingival
 Supragingival margin
• The supragingival margin has the least impact on
the periodontium.
• Classically, this margin location has been applied
in nonesthetic areas due to the marked contrast in
color and opacity of traditional restorative
materials against the tooth.
• With the advent of more translucent restorative
materials, adhesive dentistry, and resin cements,
the ability to place supragingival margins in
esthetic areas is now a reality.
 With the advent of
adhesive dentistry and
ultrathin ceramic
veneers, it now is possible
to prepare restorations
equigingival
without visible margins.
The preparations for six
porcelain veneers
with the margins placed
at the level of tissue are
shown
The completed veneers. Note
the invisible gingival fini
sh line, even though the
margin has not been carried
below tissue
• Therefore whenever possible, these
restorations should be chosen not just for
their esthetic advantages but for their
favorable periodontal impact as well.
 Equigingival margins
• The use of equigingival margins traditionally
was not desirable because they were thought
to retain more plaque than supragingival or
subgingival margins and therefore result in
greater gingival inflammation.
• There was also the concern that any minor
gingival recession would create an unsightly
margin display.
 Subgingival margin
• From a periodontal viewpoint, both supragingival
and equigingival margins are well tolerated.
• The greatest biologic risk occurs when placing
subgingival margins.
• These margins are not as accessible as
supragingival or equigingival margins for
finishing procedures, and in addition, if the
margin is placed too far below the gingival tissue
crest, it violates the gingival attachment
apparatus.
• Clinically, this information is applied to
diagnose biologic width violation when the
restoration margin is placed 2 mm or less
away from the alveolar bone and the gingival
tissues are inflamed with no other etiologic
factors evident.
• Restorative considerations frequently dictate
the placement of restoration margins beneath
the gingival tissue crest.
• Restorations may need to be extended
gingivally to create adequate resistance and
retentive form in the preparation.
• When the restoration margin is placed too far
below the gingival tissue crest, it impinges on the
gingival attachment apparatus and creates a
violation of biologic width.
• Two different responses can be observed from
the involved gingival tissues.
• One possibility is that bone loss of an
unpredictable nature and gingival tissue
recession occur as the body attempts to recreate
room between the alveolar bone and the margin
to allow space for tissue reattachment.
• This is more likely to occur in areas where the
alveolar bone surrounding the tooth is very
thin. Trauma from restorative procedures can
play a major role in causing this fragile tissue
to recede.
• The first step in using sulcus depth as a guide
in margins placement is to manage gingival
health.
• Once the tissue is healthy, the following three
rules can be used to place intracrevicular margins.
• RULE 1-If the sulcus probes 1.5mm or less, place
the restoration margin 0.5mm below the gingival
tissue crest. This is especially important on the
facial aspect and prevents a biologic width
violation in a patient who is at high risk in that
regard.
• RULE 2-If the sulcus probes more than 1.5mm,
place the margin one half the depth of the sulcus
below the tissue crest. This places the margin far
enough below tissue so that it still is covered if
the patient is at higher risk of recession.
• RULE 3-If a sulcus greater than 2mm is found,
especially on the facial aspect of the tooth,
then evaluate to see whether a gingivectomy
could be performed to lengthen the teeth and
create a 1.5mm sulcus. Then the patient can
be treated using Rule 1.
• Orkin et al. (1987) demonstrated that
subgingival restorations had a greater chance
of bleeding and exhibiting gingival recession
than supragingival restorations.
• Waerhaug (1978) stated that subgingival
restorations are plaque-retentive areas that are
inaccessible to scaling instrument.

• These retentive areas continue to accumulate

plaque even in the presence of adequate
supragingival plaque control. Stetler &
Bissada (1987) evaluated the effects of width
of keratinized gingival and subgingival
restorations on periodontal health.
• Subgingival margins demonstrated increased
plaque, gingival index scores, and probing
depths.
BIOLOGIC WIDTH CONCEPT & DENTAL
IMPLANT
• The implant-epithelium junction is similar to
that in the natural dentition, except that it is
shorter and thinner than the toothepithelium
junction.
• Because of the absence of a cementum layer
around an implant, most connective-tissue
fibers in supracrestal region are oriented in a
direction parallel to the implant surface.
• The biological width around implants can have
significant influence on the character of soft
tissues and depends on a variety of
characteristics that include implant design,
presence of adjacent teeth and quality of soft
tissue.
• For example, onepiece implant designs have
been implicated in more closely mimicking the
biological width around natural teeth.
• Similarly, platform switching (as in controlling the
dimension of the abutment) during the period of
osseointegration affects biological width by altering the
position of the microgap and controlling circumferential
bone loss around dental implants.
• In addition, a scalloped implant platform is available
thatfollows the osseous structure of the maxillary anterior
teeth and may prevent interproximal crestal bone
resorption during healing.
• These results may have important implications when
dealing with esthetic implant-borne restorations,
considering that longterm esthetic survival depends on
soft-tissue dimensions that remain healthy and vertically
constant over time.
 REFERENCE
1. Garguilo AW, Wentz FM, Orban B. Mitotic activity
of human oral epithelium exposed to 30 percent
hydrogen peroxide. Oral Surg Oral Med Oral Path
1961;14:474-92
2. Rosenburg ES, Garber DA, Evian CL: Tooth
lengthening procedures.Compend Contin Educ Dent
1980; 1:161
3.Carranza’s clinical periodontology 10th edition
4.www.google.com
5.www.youtube.com
THANK YOU