Periodontal response to long‐term abuse of the gingival attachment by supracrestal amalgam restorations

Abstract The combined length of the supracrestal connective tissue attachment and the junctional epithelium is referred to as the “biologic width”. The long‐term (1‐year) effect of complete violation of the supracrestal connective tissue attachment was examined in beagle dogs. Full thickness periodontal flaps were elevated, exposing the buccal bony crests of the maxillary and mandibular canines of 3 beagle dogs. The roots of the experimental teeth were planed and class V cavities were prepared. The apical border of each cavity was located at the alveolar bone crest. The cavities were restored with amalgam and the flaps were repositioned and sutured. In the control sites, a notch was prepared at the CEJ and the distance between the notch and the bony crest was measured. The dogs were sacrificed 57 weeks after the operation and the experimental and control sites prepared for histologic analysis. Every 5th section was examined and measurements were taken of the amount of gingival and bone recession, the length of the connective tissue and the epithelial attachment. Control sites healed uneventfully. Gingival recession averaged only 0.5 mm; bone loss was minimal and averaged 0.15 mm. The combined length of the supracrestal connective tissue and epithelial attachment measured 4.47 mm. In experimental sites, the gingiva receded 3.16 mm on average. Moderate bone loss (x̄=1.17 mm) was noted, but no signs of bone resorption were seen at the time of sacrifice. After bone loss, root surfaces which were previously attached to alveolar bone by periodontal ligament were mainly (0.90 mm) attached to connective tissue. Mild inflammatory infiltrate was observed in the lamina propria primarily at the restoration area. It is concluded that continuous abuse of the gingival attachment results in a certain loss of the periodontal attachment apparatus. The biologic width is partially restored by a more apical location of a. reduced‐in‐size, supracrestal connective tissue attachment.