Gingival Inflammation Clinical Trial
Official title:
Gingival Inflammatory Response, Bacterial Adhesion And Patient Satisfaction Of Ceramo-Metallic Vs Zirconia Crowns (Randomized Clinical Study)
Ceramo metallic restoration has proved high success rate over past years as considered to be the gold standard while Monolithic zirconia as fixed dental prostheses have gained attention because of their good fracture strength, low wear of the enamel antagonist and pleasant color .Material composition will affect gingival health and biofilm formation which initiate caries and periodontal diseases.
For years, the ceramo-metal restoration has been the gold standard in crown and bridge
procedures .They have been used for many years and studied extensively. Studies have
demonstrated a 94% success rate over a 10-year period and good long-term clinical
reliability. Although chipping of veneering porcelain is a possible complication, fracture of
the metal framework is uncommon . They require sufficient tooth reduction to allow space for
at least 0.3 mm of metal coping and 0.7 mm of veneering porcelain, and a minimum facial
reduction of 1.2 mm according to Hobo and Shillingburg. When comparing ceramo-metallic crowns
to zirconia crowns, several points are noteworthy. Laboratory testing has determined that the
fracture strength of a ceramo-metallic crown using 1.5 mm reduction is similar to zirconia
crowns with only 1 mm of reduction5. Some manufacturers have even suggested a 0.6 mm minimum
reduction for posterior zircona crowns. Which has led some dentists to prescribe all-zirconia
restorations to preserve tooth structure6 Zirconia became popular in dentistry because of the
material's excellent mechanical properties which include high strength, fracture toughness
and biocompatibility.New monolithic CAD/CAM restorative materials are designed to improve the
optical and mechanical properties of the avoid veneering failure .To increase translucency
and aesthetics of full-contour zirconia ,some modifications ,such as sintering temperature
,fabrication processes and addition of colouring liquids have been applied. These
modifications may affect the mechanical and autocatalytic surface-transformation
((low-temperature degradation (LTD)) properties of zirconia.) The primary etiologic factor of
gingival inflammation is a plaque, and by inadequate crown shape its accumulation can be
facilitated . A single crown can cause inflammation of the periodontal tissue, if the
hygienic principles have not been observed during its production. If the finish line of the
artificial crown disrupts the biologic width and is placed in the connective tissue
attachment area, the inflammation may occur. Even with increased hygiene, the gingival
inflammation can occur, if the crown preparation margin is located deeply subgingivally
Taking care of the periodontal tissue health the precision of the preparation margin,
tightness of proximal contacts, conformity of the tooth crown anatomic shape, occlusal
morphology and surface smoothness must be checked . The contact of the crown and the tooth
must be tight and uniform .
While choosing material for crown production it must be taken into account that the bacterial
adhesive capacity of the prosthetic material is affected by the surface roughness
.asperities, free energy of the surface and composition of materials (it is the lowest for
ceramic, but the highest for acrylates).Early-colonizing bacteria play a pivotal role for the
subsequent adhesion of cariogenic microorganisms such as Streptococcus mutans and periodontal
pathogens such as Tannerella forsythensis, Porphyromonas gingivalis and Aggregatibacter
actinomycetemcomitans, which may induce gingival and periodontal inflammation Periodontal
diagnosis generally requires measurement of periodontal tissue destruction (e.g., probing
pocket depth [PPD] and clinical attachment level [CAL]) and gingival inflammation (e.g.,
bleeding on probing [BOP] and gingival index [GI]). Although the techniques used are
straightforward and noninvasive. These parameters are static and thus reflect disease history
and not present disease activity .Therefore, it is necessary to develop diagnostic tests that
can identify active periodontal sites, predict future disease progression, and assess
response to periodontal treatment. Periodontopathic bacteria increase the risk of
periodontitis, and immune responses against bacterial products and subsequent secretion of
proinflammatory cytokines are crucial in periodontal tissue destruction .Interleukin-1β
(IL-1β) is an important mediator of inflammatory response and is involved in cell
proliferation, differentiation, and apoptosis, and in the pathophysiology of periodontitis.
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