Fixed Partial Dentures and Operative Dentistry

Fixed partial denturesand
operativedentistry
Facial and lingual contours of artifkia# compkte crown

restorations and their effects on the periodontium
Ralph A. Yuodelis, D.D.S., M.S.D.,* James D. Weaver, D.D.S.,** and

Stanley Sapkos, D.D.S.***
University of Washington School of Dentistry, Seattle, Wash., and
University of Alberta, Alberta, Ontario, Canada
A successful restoration must be considered from the point of view of contour,

occlusal anatomy, marginal adaptation, proximal contacts, esthetics, and function.
The tooth must be looked upon as a harmonious part of the whole dentition. Al
of the above factors are equally important in the success of any dental restoration.
The correct external morphology of all restorations is important, but this must be
borne in mind particularly during dental procedures involving full-coverage restora-
tions, It is the complete artificial crown that most taxes our ability to recreate the
original anatomy. For this reason, the facial and lingual contours of full-coverage
restorations and their relationships to periodontal health will be discussed from all
aspects.
It has been frequently stated that the purpose of the facial and lingual enamel
bulge of human teeth is to protect the free gingival margin from the traumatic
effects of mastication.l-+ It has been supposed that this bulge deflects food over the
gingival crevice and onto the keratinized gingival tissues, which are better able to
withstand the impact of the food. This theory has long been supported and has
not been seriously challenged.
Microbial plaque, especially that which is close to or nearly in contact with
the free gingival margin, is the principal etiologic factor in both caries and perio-
dontal disease.5-8 Clinically, it is evident that plaque retention is greatest in regions
that are relatively inaccessible to routine oral-hygiene measures. These regions are
the interproximal and the facial and lingual cervical areas of the teeth. To main-
tain these vulnerable regions in a plaque-free state, the close relationship between
the morphologic characteristics of the clinical crown and the degree of accessibility
must be realized and remembered.
*Professor and Director, Graduate Restorative Dentistry.

**Instructor, Department of Restorative Dentistry.
***Associate Professor and Chairman, Department of Periodontics.
61
62 Yuodelis, Weaver, and Sapkos J. Pmsthet. Dent.
January, 1973
Fig. 1. Section through the mesiobuccal cusp of a mandibular first molar from a human
specimen. Note the lingual incline of the tooth in the alveolus which flattens the contour of
the buccal aspect of the tooth.
Overcontouring, ostensibly to protect the gingival crevice from food particles

passing over the tooth surface, encourages the accumulation of particulate and
microbial matter in an area inaccessible for cleaning by the patient. It is, in fact,
doubtful that the gingival sulcus is in need of extra protection for the following
reasons :
1. There is very little in our modern diets that could injure the free gingival
margin.
2. Proprioceptive response usually provides adequate protection for the free
gingiva during mastication of hard foods.
3. The potential impact of food as the crushed bolus passes over the axial con-
tour of the teeth is usually dissipated by the time the food reaches the gingiva.
4. Most of the crushed bolus never reaches the gingiva, since it is directed by
the cheeks, lips, tongue, and other parts of the mouth into a position for deglutition.
5. Most human dentitions have little if any clinical bulge and yet show no
deleterious effects of mastication. For example: (a) The facial bulges of deciduous
and adolescent dentitions are below the crest of the gingiva, and yet these tissues
do not suffer trauma from mastication. (b) The slight bulge that is present on the
facial side of mandibular posterior teeth becomes ineffective for food deflection,
because these teeth are usually lingually inclined (Fig. 1) . Conversely, this same
inclination exaggerates the lingual height of convexity and causes almost all of the
lingual surface of the crown to become an area of stagnation9 (c) Dentitions suf-
fering from such abnormalities as enamel hyperplasia or peg-shaped incisors do
not have cervical bulges but do demonstrate normal gingival tissue (Fig. 2).
?z%r
:” Contours of crown restorations and periodontium 63
Fig. 2. A mandibular peg-shaped lateral incisor in a 32-year-old subject. The tooth lacks
contour but has excellent gingival health.
Fig. 3. Photograph of a dog mandible showing lack of facial surface convexity since the
enamel bulge is below the free gingival margin.
Fig. 4. Disclosing solution demonstrates plaque retention in the cervical regions of the teeth.
Fig. 5. The temporary crowns were fractured, and the patient failed to return for repiace-
ments for several months. Despite the lack of contour, the tissues remained healthy.
6. The dentitions of lower species of animals do not provide this theoretical

protection, since any buccal and lingual bulges are usually subgingival (Fig. 3).
This also demonstrates that proprioceptive response is most important. The diets
of the lower animals include foods that are much coarser and potentially traumatic
to the gingiva, however, it is difficult to demonstrate traumatic effects of mastication,
In an experiment to ascertain how tooth contours affect the gingiva, PeAlo
remodeled the mandibular teeth of full-grown mongrel dogs, removing tooth struc-
ture from either buccal, labial, or lingual surfaces, each in different parts of the
jaw. Overcontouring of the buccal surfaces was done with self-curing resin, which
was not in contact with the gingiva. The results showed that undercontouring
caused no apparent gingival pathoses; whereas overcontouring gave rise first to
inflammation and later to the collection of debris, hyperplasia and engorgement
of the marginal gingiva, scant keratinization, and deterioration of the fibers of the
gingival collar. The unhealthy state of the gingiva after four weeks of overcontouring
revealed that the so-called “protective” convexity not only served as a food trap
but also prevented massage of the gingival margin.
In our opinion, this cervical bulge overprotects the microbial plaque. Plaque
buildup begins in, and its retention is greatest in, the cervical region of the tooth
64 Yuodelis, Weaver, and Sapkos J. Prosthet. Dent.
January, 1973
Fig. 6. The original anatomic crown was altered to eliminate the cervical bulge. This facili-
tated oral hygiene to maintain the plaque-free cervical regions.
gingival to the height of contour. 1x, l2 This can be readily demonstrated by the
use of disclosing solution (Fig. 4).
The greater the degree of facial and lingual bulge, the more plaque retained
in the cervical region; the flatter the contour, the less plaque retained. The explana-
tion for this lies in the accessibility to oral-hygiene measures. It is easier to keep the
portion of the tooth occlusal to the height of contour plaque free than the cervical
region gingival to the height of contour. Unless given special instructions in brushing
and use of floss or such devices as Stim-u-dents* and Perio-Aids,+ which are
specifically designed to remove plaque in the cervical region, most patients will
miss the plaque in the cervical region that is gingival to the height of contour due
to the overprotection given to this region by the height of contour and the free
gingival margin. On many occasions, we have observed the response of the gingiva
to posterior teeth that have been prepared for complete artificial crowns and have
lost their temporary crowns (Fig. 5). In all instances, the free gingival margin
remained healthy, and the cervical regions of such teeth demonstrated very little
plaque retention compared with that of approximating unprepared teeth.13 We
have never observed teeth with little or no facial or lingual curvature that demon-
strated a free gingival margin that had been stripped or pushed apically because
of lack of protection and consequent overstimulation. We have, however, observed
many teeth with excessively bulky contours which demonstrated disturbances at-
tributable to the overprotection of the free gingival margin and which, in conse-
quence, suffered microbial plaque retention because the patients were unable to
reach the areas by routine oral-hygiene measures.
After periodontal therapy that involves osseous resection procedures or following
gingival recession, we are often confronted with longer-than-normal clinical crowns.
These lengthened clinical crowns are much more difficult to keep plaque free due
to the exposed furcations and root flutings. If plaque is allowed to accumulate for
Wtim-u-dent, Inc., Detroit, Mich.

+Marquis Dental Mfg. Company, Denver, Golo.
Volume 29 Contours of crown restorations and periodontium 65
Number 1
Fig. 7. Note the triangular region of the mandibular molar created by the root contour and
cervical bulge. Plaque retention in this area is demonstrated by using disclosing solution.
long periods of time, demineralization of the cemental surfaces will rapidly cause
increased sensitivity and root caries. If root portions must be covered by complete
artificial crowns, the gold castings should not frustrate the oral-hygiene efforts of
the patient.
The final restoration should not follow the original anatomic crown and should
recreate the original contours of the root portion. The modification of the anatomic
coronal form entails reduction of unnecessary bulges in order to create additional
accessibility to the gingival third of the fluted and furcation regions (Fig. 6). This
will eliminate the triangular region (Fig. 7) that is created by the roots and the
cervical bulge and which is the area most difficult to maintain in a plaque-free
condition by normal brushing. For these reasons, we endeavor to flatten the facial
and lingual contours of restorations and have observed excellent gingival response:
most probably because the cervical region is made more accessible for routine
home care.
The authors wish to express their gratitude to Alison Ross and Judy Kotar for their as-
sistance in preparing this paper for publication.
References
1. Wheeler, R. C.: Natural Tooth Form and Dental Maintenance, J. South. Calif. State
Dent. Assoc. 31: 382-390, 1963.
2. Terkla, L. G.: Crown Morphology in Relation to Operative and Crown and Bridge
Dentistry, Ore. State Dent. J. 5: 2-10, 1955.
3. Wheeler, R. C.: Complete Crown Form and the Periodontium, J. PROSTHET. DENT. 11:
722-734, 1961.
4. Kraus, B. S., Jordan, R. E., and Abrams, L.: Dental Anatomy and Occlusion, Baltimore,
1969, The Williams & Wilkins Company.
5. Gibbons, R. J.: Some Aspects of the Bacteriology of Periodontal Disease, Int. Dent. J,
14: 407-410, 1964.
6. Frank, R. M., and Brendel, A.: Ultrastructure of the Approximal Dental Plaque and the
Underlying Normal and Carious Enamel, Arch. Oral Biol. 11: 883-912, 1966.
66 Yuodelis, Weaver, and Sapkos J. Prosthet. Dent.
January, 1973
7. L6e, H., Theilade, E., and Jensen, S. B.: Experimental Gingivitis in Man, J. Periodontol.
36: 177-187, 1965.
8. Sharawy, A. M., et al.: A Quantitative Study of Plaque and Calculus Formation in Normal
and Periodontally Involved Mouths, J. Periodontol. 37: 495-501, 1966.
9. Veldcamp, D. F.: The Relationship Between Tooth Form and Gingival Health, Dent.
Pratt. Dent. Rec. 14: 158-159, 1963.
10. Perel, M. L.: Axial Crown Contours, J. PROSTHET. DENT. 25: 642-649, 1971.
11. Herlands, R. E., Lucca, J. J., and Morris, M. L.: Forms, Contours, and Extensions of Full
Coverage in Occlusal Reconstruction, Dent. Clin. North Ah., March, 1962, p. 147.
12. Ramfjord, S.: Local Factors in Periodontal Disease, J. Am. Dent. Assoc. 44: 647-655,
1952.
13. Morris, M. L.: Artificial Crown Contours and Gingival Health, J. PROSTHET. DENT. 12:
1146-1156, 1962.
UNIVERSITY OF WASHINGTON
SCHOOL OF DENTISTRY
SEATTLE, WASH. 98195

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Fixed partial denturesand

Facial and lingual contours of artifkia# compkte crown

Ralph A. Yuodelis, D.D.S., M.S.D.,* James D. Weaver, D.D.S.,** and

A successful restoration must be considered from the point of view of contour,

*Professor and Director, Graduate Restorative Dentistry.

Overcontouring, ostensibly to protect the gingival crevice from food particles

6. The dentitions of lower species of animals do not provide this theoretical

Wtim-u-dent, Inc., Detroit, Mich.

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